The association between organised colorectal cancer screening strategies and reduction of its related mortality: a systematic review and meta-analysis.

BACKGROUND: To assess the long-term association between organised colorectal cancer (CRC) screening strategies and CRC-relate mortality. METHODS: We systematically reviewed studies on organised CRC screening through PubMed, Ovid Medline, Embase and Cochrane from the inception. We retrieved characteristics of organised CRC screening from included literature and matched mortality (over 50 years) of those areas from the International Agency for Research on Cancer in May 2023. The variations of mortality were reported via the age-standardised mortality ratio. A random-effects model was used to synthesis results. RESULTS: We summarised 58 organised CRC screening programmes and recorded > 2.7 million CRC-related deaths from 22 countries where rollout screening programmes were performed. The CRC screening strategy with faecal tests (guaiac faecal occult blood test (gFOBT) or faecal immunochemical tests (FIT)) or colonoscopy as the primary screening offer was associated with a 41.8% reduction in mortality, which was higher than those offered gFOBT (4.4%), FIT (16.7%), gFOBT or FIT (16.2%), and faecal tests (gFOBT or FIT) or flexible sigmoidoscopy (16.7%) as primary screening test. The longer duration of screening was associated with a higher reduction in the pooled age-standardised mortality ratio. In particular, the pooled age-standardised mortality ratio became non-significant when the screening of FIT was implemented for less than 5 years. CONCLUSIONS: A CRC screening programme running for > 5 years was associated with a reduction of CRC-related mortality. Countries with a heavy burden of CRC should implement sustainable, organised screening providing a choice between faecal tests and colonoscopy as a preferred primary test.

Associations of obesity indices change with cardiovascular outcomes: a dose-response meta-analysis.

BACKGROUND: Little is known about the degrees and shapes of associations of changes in obesity indices with cardiovascular disease (CVD) and mortality risks. We aimed to conduct a dose-response meta-analysis for the associations of changes in weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio, and waist-to-height ratio with CVD events, CVD-specific deaths, and all-cause mortality. METHODS: We searched MEDLINE via OvidSP, Embase via OvidSP, Web of Science, CINAHL, and Scopus for articles published before January 8th, 2023. Dose-response relationships were modeled using the one-stage mixed-effects meta-analysis. Random-effects models were used to pool the relative risk (RR) and 95% confidence interval (CI). RESULTS: We included 122 articles. Weight change was negatively associated with deaths from CVD and any cause, while WC change elevated CVD-specific mortality. Non-linear relationships also confirmed the adverse effects of increased WC on CVD-specific mortality. Additionally, gains of 5 kg in weight and 1 kg/m2 in BMI or more were associated with elevated CVD events, especially among young adults and individuals without CVD. Conversely, reductions of 5 kg in weight and 1 kg/m2 in BMI or more were associated with higher CVD-specific and all-cause deaths than increased counterparts, particularly among old adults and individuals with CVD. Similar non-linear relationships between relative changes in weight and BMI and deaths from CVD and any cause were observed. CONCLUSIONS: The effects of changes in weight and BMI on CVD outcomes were affected by age and cardiovascular health. Tailored weight management and avoidance of increased WC should be recommended.

Adoption of colonoscopy surveillance intervals in subjects who received polypectomy in southern China: A cost-effectiveness analysis.

BACKGROUND AND AIM: We aimed to evaluate the cost-effectiveness of different colonoscopy intervals among average-risk (5 vs 10 years) and high-risk (1 vs 3 years) southern Chinese populations. METHODS: We constructed a Markov model with a hypothetical population of 100 000 individuals aged 50-85 years. Average risk was defined as 1-2 non-advanced adenomas (tubular adenoma sized < 10 mm without high-grade dysplasia). High risk was defined as ≥ 3 non-advanced adenomas or any advanced adenoma (adenoma sized ≥ 10 mm, with high-grade dysplasia, or with villous/tubulovillous histology). Three strategies were compared: a 5/1 strategy (average-risk subjects: 5-year interval; high-risk subjects: 1-year interval), a 10/3 strategy, and a control strategy (a 10/10 strategy). Costs (US dollar), quality-adjusted-life-years, incremental cost-effectiveness ratio, and net health benefit were calculated. If the incremental cost-effectiveness ratio of one strategy against another was less than willingness-to-pay ($24 302 US/quality-adjusted-life-years), the strategy was more cost-effective than another. RESULTS: Compared with the 10/3 strategy, the 5/1 strategy involved more costs and effects (incremental cost-effectiveness ratio = $40 044 US/quality-adjusted life-years). When the 10/10 strategy was regarded as the control, the 5/1 strategy had a higher incremental cost-effectiveness ratio than the 10/3 strategy ($26 056 vs $10 344 US/quality-adjusted life-years). Furthermore, the 10/3 strategy had the highest net health benefit. CONCLUSIONS: A 10/3 interval was more cost-effective than a 5/1 interval. From an economic perspective, our findings supported a 10-year interval for average-risk individuals and a 3-year interval for high-risk subjects. The findings could help form the optimal colonoscopy interval for average-risk and high-risk patients.

Associations between potential causal factors and colorectal cancer risk: A systematic review and meta-analysis of Mendelian randomization studies.

OBJECTIVE: To summarize the associations between potential causal factors and colorectal cancer (CRC) risk based on existing Mendelian randomization studies. METHODS: This systematic review and meta-analysis involved a literature search in Embase and Medline. All published articles using Mendelian randomization to explore potential causal factors of CRC were included. Studies that reported Mendelian randomization estimates of standard deviation changes in exposures were included in the meta-analysis. Subgroup analyses based on sex and anatomical sites were performed. RESULTS: One hundred and ninety studies presented in 51 articles were included in systematic review, and 114 studies conducted in 32 articles were included in the meta-analysis. Adult body mass index, waist circumference, waist hip ratio, body height, body fat percentage, arm fat ratio, childhood obesity, lifetime cigarette consumption, short sleep, coffee consumption, and blood levels of vitamin B12 , arachidonic acid, stearic acid, and insulin-like growth factor binding protein 3 were positively associated with CRC risk. Conversely, acceleration-vector-magnitude physical activity, milk consumption, and blood levels of adiponectin, linoleic acid, α-linolenic acid, oleic acid, palmitoleic acid, interleukin-6 receptor subunit-α, and tumor necrosis factor were inversely associated with CRC risk. CONCLUSIONS: Most obesity-related anthropometric characteristics, several unhealthy lifestyles, and blood levels of some micronutrients, fatty acids, and diabetes-related biomarkers were positively associated with CRC risk. In contrast, some lifestyles and blood levels of some fatty acids and inflammatory biomarkers were inversely associated with CRC risk. Future studies with more valid genetic variants are needed for factors with discrepancies between Mendelian randomization and epidemiological studies.

Association of positive and adverse childhood experiences with risky behaviours and mental health indicators among Chinese university students in Hong Kong: an exploratory study.

Background: Different childhood experiences may affect adult health differently. Objective: To explore the association of different types of positive childhood experiences(PCEs) and adverse childhood experiences (ACEs) with risky behaviours and mental health indicators, andhow PCEs and ACEs are associated with health outcomes in the context of each other. Method: This was an exploratory cross-sectional online survey including 332 university students in Hong Kong. ACEs (abuse and household challenges), PCEs (perceived safety, positive quality of life, and interpersonal support), risky behaviours (smoking, binge drinking, and sexual initiation), and mental health indicators(depression, anxiety, loneliness, self-rated health, multimorbidity, meaning in life, and life satisfaction)were measured. Results: The multivariable logistic regression analysis indicated cumulative effects of PCEs in lowered risks of depression, anxiety, loneliness, as well as better self-rated health, life satisfaction, and meaning in life (p < .05), after adjusting for ACEs. Results also indicated that ACEs had an increasing relationship with poorer mental health indicators, such as anxiety, loneliness, and life satisfaction (p < .05), after adjusting for PCEs. There was also an adverse association between having ≥4 ACEs with smoking and binge drinking. In addition, each type of PCE and ACE was significantly associated with one or more risky behaviours and mental health indicators. Stratified results showed that PCEs had stronger associations with mental health indicators in participants with fewer ACEs. Furthermore, ACEs had stronger associations with mental health indicators in participants with more PCEs than in those with fewer PCEs. Conclusions: In this study, PCE was proven to be an independent protective factor against poor mental health after accounting for ACE. ACE was also proven to be an independent risk factor for poor mental health and risky behaviours. These findings suggest a crucial need for the active promotion of PCEs and the prevention of child maltreatment. The results of subtypes and stratifications can be taken into consideration when developing targeted interventions in the future. HIGHLIGHTS: PCE is an independent protective factor against poor mental health after accounting for ACE. ACE is an independent risk factor for poor mental health and risky behaviours.PCEs and ACEs have different associations with health outcomes in the context of one another.

Antecedentes: Las diferentes experiencias de la infancia pueden afectar la salud de los adultos de manera diferente.Objetivo: Explorar la asociación de diferentes tipos de experiencias infantiles positivas (EIP) y experiencias infantiles adversas (EIA) con conductas de riesgo e indicadores de salud mental, y cómo las EIP y las EIA se asocian con resultados de salud en el contexto de cada uno.Método: Esta fue una encuesta transversal exploratoria en línea que incluyó a 332 estudiantes universitarios en Hong Kong. EIA (abuso y desafíos domésticos), EIP (seguridad percibida, calidad de vida positiva y apoyo interpersonal), comportamientos de riesgo (fumar, beber en exceso e iniciación sexual) e indicadores de salud mental (depresión, ansiedad, soledad, salud autoevaluada, multimorbilidad, sentido de la vida y satisfacción con la vida) fueron medidos.Resultados: El análisis de regresión logística multivariable indicó efectos acumulativos de EIP en disminuir el riesgo de depresión, ansiedad, soledad, así como mejor autoevaluación de la salud, satisfacción con la vida y sentido de la vida (p < 0,05), después de ajustar por EIA. Los resultados también indicaron que EIA tuvo una relación de incremento con indicadores de salud mental más deficientes, como ansiedad, soledad y satisfacción con la vida (p < 0,05), después de ajustar por EIP. También hubo una asociación adversa entre tener ≥4 EIA con fumar y beber en exceso. Además, cada tipo de EIP y EIA se asoció significativamente con uno o más comportamientos de riesgo e indicadores de salud mental. Los resultados estratificados mostraron que EIP tuvo asociaciones más fuertes con indicadores de salud mental en participantes con menos EIA. Además, EIA tuvo asociaciones más fuertes con indicadores de salud mental en participantes con más EIA que en aquellos con menos EIP.Conclusiones: En este estudio, se demostró que EIP es un factor protector independiente contra una pobre salud mental después de tomar en cuenta EIA. También se demostró que EIA es un factor de riesgo independiente para una pobre salud mental y comportamientos de riesgo. Estos hallazgos sugieren una necesidad crucial para la promoción activa de EIPs y la prevención del maltrato infantil. Los resultados de los subtipos y estratificaciones se pueden tener en cuenta al desarrollar intervenciones focalizadas en el futuro.

Characteristics of participants who take up screening tests for diabetes and lipid disorders: a systematic review.

OBJECTIVES: To perform a systematic review on the characteristics of participants who attended screening programmes with blood glucose tests, lipid profiles or a combination of them, respectively. DESIGN: Systematic review following the Meta-analysis Of Observational Studies in Epidemiology checklist. DATA SOURCES: PubMed and Medline databases for English literature from 1 January 2000 to 1 April 2020. ELIGIBILITY CRITERIA: Original observational studies that reported baseline characteristics of apparently healthy adult participants screening for diabetes and lipid disorders were included in this review. DATA EXTRACTION: We examined their sociodemographic characteristics, including age, gender, body mass index (BMI) and lifestyle habits. The quality of the included articles was evaluated by the Appraisal of Cross-sectional Studies. RESULTS: A total of 33 articles involving 38 studies in 22 countries were included and analysed in this systematic review. Overall, there was a higher participation rate among subjects who were female in all screening modalities (female vs male: 46.6%-63.9% vs 36.1%-53.4% for diabetes screening; 48.8%-58.4% vs 41.6%-51.2% for lipid screening; and 36.4%-76.8% vs 23.2%-63.6% for screening offering both). Compared with the BMI standard from the WHO, participants in lipid screening had lower BMI (male: 23.8 kg/m2 vs 24.2 kg/m2, p<0.01; female: 22.3 kg/m2 vs 23.6 kg/m2, p<0.01). Furthermore, it is less likely for individuals of lower socioeconomic status to participate in diabetes or lipid screening in developed areas. CONCLUSIONS: We identified that individuals from lower socioeconomic groups were less likely to take up programmes for diabetes and/or lipid screening in developed areas. These populations are also likely to be at higher risk of non-communicable diseases. Future studies should investigate the barriers and facilitators of screening among non-participants, where targeted interventions to enhance their screening uptake are warranted.

Fighting COVID-19: a qualitative study into the lives of intensive care unit survivors in Wuhan, China.

OBJECTIVES: We aimed to provide an insight into the life of survivors of critical COVID-19 in China. METHODS: We conducted an online survey and qualitative interviews among intensive care unit survivors of critical COVID-19 between November and December 2020 in Wuhan, China. Eligible participants were asked to complete the EQ-5D-5L and the Short Form 36-Item Survey, and invited to participate in a semistructured face-to-face interview. Descriptive analyses and phenomenological approach were adopted to analyse quantitative and qualitative data, respectively. RESULTS: Of 10 survivors who completed the questionnaire, 8 participated in the interview. The mean scores±SD of EuroQol-5 Dimensions-5 Level utility and EuroQol-Visual Analogue Scale were 0.88±0.15 and 80.9±14.2, respectively. The qualitative interview identified four themes, namely poor physical health, post-traumatic stress, social stigma and family support. CONCLUSIONS: COVID-19 survivors continue fighting physical and psychological impacts. Despite strong family support, these patients are struggling with social stigma. It is a long, challenging journey to recovery for patients and society.

A Global Evaluation of the Performance Indicators of Colorectal Cancer Screening with Fecal Immunochemical Tests and Colonoscopy: A Systematic Review and Meta-Analysis.

(1) Background: To summarize the achievements of the performance indicators of colorectal cancer (CRC) screening programs that used the fecal immunochemical test (FIT) as a primary screening modality and colonoscopy as a subsequent confirmatory test. (2) Methods: PubMed, Ovid MEDLINE, Embase, and Cochrane were searched from inception to September 2020. We included original articles published in English, and performed hand searching for relevant national reports. We generated pooled achievement estimates of the performance indicators by "metaprop" (R software 3.6.3). Meta-regression analyses and subgroup analyses were also conducted. (3) Results: We included 93 studies involving nearly 90 million people-times. The participation rate ranged from 6.80% to 95.98%, which was associated with study type, continents, FIT number, age, and round. The pooled FIT invalid rate and positivity rate were 1.08% and 7.28%, respectively. The pooled estimates of FIT detection were 2.26% for adenoma, 1.26% for advanced adenoma, and 0.28% for CRC. In addition, only seven studies reported that their colonoscopy compliance rate reached 90% among 69 studies. The colonoscopy completion rate (21/40 studies > 95%) and the complication rate (18/27 studies < 0.5%) were acceptable. (4) Conclusions: Our findings could help to identify the areas that could be improved and finally optimize the CRC screening programs.

The cost-effectiveness of starting 23-valent pneumococcal polysaccharide vaccine and influenza vaccination at 50 vs. 65 years: A comparative modelling study.

OBJECTIVES: Pneumococcal infection is a leading cause of morbidity and mortality. We aimed to evaluate the cost-effectiveness of 23-valent polysaccharide vaccine (PPV23) together with influenza vaccination or pneumococcal vaccination alone in adults starting from 50 years vs. 65 years in Hong Kong. METHODS: A hypothetical population of 100,000 older adults was included in a Markov model with age ranging from 50 to 85 years to calculate the cost and quality-adjusted life-years (QALYs) gained for vaccination strategies, including: (1) annual influenza vaccine and PPV23 at 50 and 65 years; (2) annual influenza vaccine and PPV23 at 65 years (similar with the current vaccination programme); (3) PPV23 at 50 and 65 years; (4) PPV23 at 65 years; and (5) no vaccination. We evaluated the incremental cost-effectiveness ratio (ICER) and used Monte Carlo simulation for probabilistic sensitivity analysis. The cost-effectiveness threshold was extracted from previous literature. RESULTS: In comparison with no vaccination, all strategies were cost-effective with ICERs less than the threshold (US$24,302 per QALY gained). When compared with no vaccination, strategies 1-4 saved US$ 49.5, US$ 94.9, US$ 584.3, and US$ 1114.2 to gain one QALY respectively. In comparison with strategy 2, strategy 1 spent US$ 195.3 to gain one QALY, whilst strategies 3 and 4 showed less effectiveness with increased costs. CONCLUSIONS: All vaccination strategies were cost-effective, among which the strategy of PPV23 at 50/65 years with annual influenza vaccine was cost-effective even in comparison with current vaccination programme. These findings could help inform the design and implementation of vaccination strategies.

Acceptance of pneumococcal vaccination in older adults: A general population-based survey.

BACKGROUND: Pneumococcal infection is a leading cause of disability and death globally. The Hong Kong Government has launched two programmes for pneumococcal vaccination - The Vaccination Subsidy Scheme (VSS) and the Government Vaccination Programme (GVP). This study aimed to examine the enabling factors, obstacles and perception of pneumococcal vaccination, and their association with its uptake in a general Chinese population. METHODS: We performed a population-based, telephone survey in the general public aged 65 or above via simple random sampling. A validated survey based on the Health Belief Model (HBM) was used. Their socio-demographic information; history of previous participation in the GVP or VSS; and self-perceived health status were captured. Binary logistic regression models were constructed to examine the factors independently associated with vaccination. RESULTS: A total of 1,000 respondents were enrolled in the study, with 402 (40.2%) respondents having intention to join the GVP/VSS in 12 months. Respondents with long-term medical consultant and medication (adjusted odds ratios [aOR] = 1.541, 95% confidence interval (CI): 1.008-2.356, p = 0.046); high levels of perceived susceptibility of infections (aOR = 3.624, 95 %CI: 2.318-5.665, p < 0.001); high levels of perceived benefits of vaccine (aOR = 1.699, 95 %CI: 1.153-2.504, p < 0.001); recommendations from government (aOR = 8.025, 95 %CI: 4.771-13.497, p < 0.001) or physicians (aOR = 7.399, 95 %CI: 3.472-15.764, p = 0.008); and high levels of self-efficacy (aOR = 3.045, 95 %CI: 1.458-6.362, p = 0.003) were more likely to have intention to participate in the vaccination programme. CONCLUSIONS: The acceptance rate of pneumococcal vaccination programme remained suboptimal in the population. The government and physicians should be involved in the promotion of pneumococcal vaccination and GVP/VSS by increasing perceived benefits and self-efficacy, and reducing barriers towards vaccination among the target population. More studies are required to confirm our findings in other settings.

Global incidence and mortality of breast cancer: a trend analysis.

This study aimed to evaluate the global incidence and mortality trends of breast cancer among females by region and age in the past decade. We retrieved country-specific incidence and mortality data from the Global Cancer Observatory up to 2018 and Cancer Incidence in Five Continents volumes I-XI, the Nordic Cancer Registries, the Surveillance, Epidemiology, and End Results, and WHO mortality database up to 2016. The temporal patterns were using Average Annual Percent Change (AAPC) with the 95% confidence interval (CI) by joinpoint regression analysis. Most countries showed an increasing trend in incidence. For the older population aged ≥ 50 years, Japan (5.63, 4.90-6.36), Slovakia (3.63, 3.03-4.22), China (2.86, 2.00-3.72) reported the most prominent increase. For young females (<50 years), Japan (AAPC=3.81, 95% CI=2.71-4.93), Germany (AAPC=2.60, 95% CI=1.41-3.81) and Slovakia (1.91, 1.13-2.69) reported the most drastic rise. Similarly, 12 countries showed an incidence increase among women aged <40 years. As for mortality, the Philippines (4.36, 3.65-5.07), Thailand (4.35, 3.12-5.59), Colombia (0.75, 0.08-1.42), and Brazil (0.44, 0.19-0.68) reported a significant increase. The disease burden of breast cancer showed an increasing trend in a large number of populations. More preventive efforts are recommended for these countries. Further research should explore the underlying reasons for these epidemiological trends.

Differences in Incidence and Mortality Trends of Colorectal Cancer Worldwide Based on Sex, Age, and Anatomic Location.

BACKGROUND & AIMS: We studied incidence and mortality trends of colorectal cancer (CRC) in 39 countries according to age, sex, and anatomic location (colon vs rectum). METHODS: We retrieved incidence data from registries from 36 countries. The registries included the following: Cancer Incidence in 5 Continents volumes I to XI; the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute; and the Nordic Cancer Registries from Europe. We obtained mortality data from 39 countries of the World Health Organization database. We evaluated average annual percentage changes in CRC incidence and mortality in the past decade using joinpoint regression analysis. RESULTS: From 2007 to 2016, 2006 to 2015, or 2005 to 2014, depending on the availability of the data, the incidence of colon cancer increased in 10 of 36 countries analyzed (all in Asia or Europe); India had the greatest increase, followed by Poland. All 10 of these countries have medium to high Human Development Index (HDI) scores. Six countries had a decrease in colon cancer incidence; these countries had the highest HDI scores; the United States had the greatest decrease, followed by Israel. Seven countries (including all countries from Northern America) had a decrease in incidence among persons older than 50 years. Eight countries had an increase in colon cancer incidence among persons younger than 50 years, including the United Kingdom and India. Countries with a decreased or stable incidence among persons 50 years or older but a significant increase in persons younger than 50 years, included Germany, Australia, the United States, Sweden, Canada, and the United Kingdom. Only Italy had a decrease in CRC incidence among persons younger than 50 years. Among women, 12 of 36 countries (all from Asia and Europe) had an increase in colon cancer incidence and 7 countries had a decrease; India had the greatest increase followed by Slovenia. Five of 36 countries had an increase in incidence of rectal cancer and 8 countries had a decrease; Ecuador and Thailand had the greatest increases in incidence. The incidence of rectal cancer among persons younger than 50 years increased significantly in Finland, Australia, Canada, the United States, and The Netherlands. Four countries had an increase in the incidence of rectal cancer in women; Ecuador had the greatest increase followed by Thailand. The incidence of rectal cancer in women decreased in 8 countries. Among women younger than 50 years, rectal cancer incidence increased, despite a decrease in women older than 50 years, in Costa Rica, Slovenia, Japan, Slovakia, Canada, and the United States there was an increase in incidence, although their elder population had a stable or decreased incidence. Twenty-four countries reported a reduction in CRC mortality, including North America, Oceania, and most European countries. Nevertheless, some countries from Asia, Latin America, and Southern Europe had significant increases in CRC mortality. CONCLUSIONS: In an analysis of incidence and mortality databases from 39 countries, we found that the incidence of colon and rectal cancers has continued to increase in countries with medium to high HDI and in younger populations. Preventive strategies are needed for countries with increasing CRC and rectal cancer incidence and mortality.

Using a Chinese time trade-off approach to explore the health utility level and quality of life of cancer patients in urban China: a multicentre cross-sectional study.

PURPOSE: A quality of life assessment is useful in identifying a specific health impact on patients who are suffering from various medical conditions. This study estimated the quality of life among patients with cancers of the lungs, breast, colorectum, oesophagus, liver, and stomach in urban China and evaluates the associated factors. METHODS: This study employed a random cluster sampling strategy to recruit patients with lung, breast, colorectal, oesophageal, liver, or stomach cancer from eleven third-grade class-A (the highest level) hospitals in Beijing between October 2013 and May 2014. We performed a quality of life survey that included solicitation of sociodemographic and clinical information and the use of a EuroQoL five-dimension three-level questionnaire. We applied the Chinese time trade-off method to calculate the health utility values, which were transformed into binary variables (using the median as the cut-off). In addition, multivariable logistic regression analysis was used to examine the factors associated with the quality of life. RESULTS: A total of 637 patients (91 with lung cancer, 152 with breast cancer, 60 with colorectal cancer, 108 with oesophageal cancer, 154 with liver cancer, and 72 with stomach cancer) were included in this study; the medians of the health utility values were 0.780, 0.800, 0.800, 0.860, 0.800, and 0.870, respectively. The most common concerns for patients of all six cancer types were pain/discomfort and anxiety/depression. The reported health status of patients was associated with various demographic and clinical variables. CONCLUSION: This study highlighted that pain relief and psychological support are important aspects of patient management for those with these types of cancer. Individuals with factors associated with a poorer quality of life should be targets for additional support.

Factors associated with participation in colorectal cancer screening: A population-based study of 7200 individuals.

OBJECTIVE: This study aimed to evaluate how the knowledge and perception towards colorectal cancer (CRC) screening had been changed in a large population, and identified factors associated with its participation based on factors pertinent to the Health Belief Model (HBM). METHODS: Data from 3600 screening participants and 3600 non-participants were collected through a telephone survey via simple random sampling of telephone numbers in a territory-wide directory from December 2016 to November 2018. Sociodemographic factors; the enabling factors of screening as well as the barriers of screening were collected. The changes in these factors were evaluated by Pearson's chi-square trend test. A logistic regression model was constructed to identify the association between the above factors and CRC screening participation. RESULTS: The knowledge level (67.9% to 85.4%, p < 0.001), perceived severity of having CRC (37.7%-42.8%, p < 0.01), perceived benefits of screening (54.9%-72.1%, p < 0.001), and reductions in barriers (14.1%-5.1%, p < 0.001) of CRC screening significantly improved among the non-users. Subjects with older age (adjusted odds ratio (AOR): 2.01, p < 0.001), higher knowledge level of screening methods (AOR: 6.68, p < 0.001), greater perceived severity (AOR: 2.04, p < 0.001) and coverage of insurance (AOR: 1.22, p < 0.01) were more likely to participate. In contrast, more affluent subjects (AOR: 0.69, p < 0.001), female individuals (AOR: 0.63, p < 0.001), higher level of perceived psychological (AOR: 0.54, p < 0.001) and access barriers (AOR: 0.55, p < 0.001) were associated with poorer participation. CONCLUSION: These findings demonstrated a substantial increase in the enabling factors of CRC screening, including knowledge, perceived severity and perceived benefits. The study also identified the target groups such as younger individuals, females and more affluent people among whom more intensive educational initiatives are needed to enhance their participation.

Prevalence and risk factors of colorectal cancer in Asia.

Globally, colorectal cancer (CRC) is a substantial public health burden, and it is increasingly affecting populations in Asian countries. The overall prevalence of CRC is reported to be low in Asia when compared with that in Western nations, yet it had the highest number of prevalent cases. This review described the prevalence of CRC in Asia according to the International Agency for Research on Cancer from World Health Organization (WHO) database and summarized its major risk factors. Non-modifiable factors include genetic factors, ethnicity, age, gender, family history and body height; smoking, alcohol drinking, weight, Westernized diet, physical inactivity, chronic diseases and microbiota were involved in environmental factors. These risk factors were separately discussed in this review according to published literature from Asian countries. CRC screening has been playing an important role in reducing its disease burden. Some recommendations on its screening practices have been formulated in guidelines for Asia Pacific countries.

Cost-utility analysis of screening for colorectal precancerous lesions and cancer in Beijing: A case-control study.

OBJECTIVE: To provide an objective cost-utility evaluation of a colorectal cancer screening program in a hypothetical general population. MATERIALS AND METHODS: A cost-utility analysis was conducted comparing screened individuals with the general population. Patients were evaluated as part of the screening program which conducted colorectal cancer risk assessments and performed colonoscopies from October 2012 to May 2013. Data were compared to a hypothetical group of the same size, consisting of the general population in which no cancer screening had been conducted. The cost and utility data have been published previously. RESULTS: The average cost per quality-adjusted life year (QALY) of colorectal cancer screening population was 84,092 CNY, while the average cost per QALY of the general population was 122,530 CNY. The colorectal cancer screening program saved 43,530 CNY per additional QALY. CONCLUSION: The colorectal cancer screening program could improve health-related quality of life and reduce medical expenditure.