Personalized colorectal cancer screening in high-risk groups

Introduction

Colorectal cancer (CRC) is one of the leading oncological diseases in Russia. The Yaroslavl region is experiencing an increase in the number of registered CRC cases, reflecting general demographic trends and risk factors. Two-stage screening using FIT contributes to improved early diagnosis and reduced mortality, which is relevant for regional practice. At the same time, a trend of increasing CRC incidence in individuals under 50 years of age is noted. In the Yaroslavl region, the increase in incidence among people of both sexes under the age of 50 was 56.3% $1$. This confirms the need for effective preventive programs. In the Yaroslavl region, two-stage screening using the faecal immunochemical test (FIT) is being implemented, aimed at detecting precancerous pathology, early forms of cancer, and reducing mortality. Personalizing the screening strategy, taking into account age characteristics, significantly increases the effectiveness of primary and subsequent examinations $2-4$.

Materials and methods

The study included 1,105 employees of the "YANOS" industrial enterprise in the Yaroslavl region, aged 38 years and older. This production facility is characterized by the presence of increased hazard factors, including chemical, physical, and other occupational risks, which justifies classifying this cohort as a group with an increased predisposition to developing oncological diseases, particularly colorectal cancer. Considering the occupational hazards and their potential impact on carcinogenesis, examining this category of workers is of significant interest for assessing the effectiveness of preventive measures and early cancer diagnosis. Screening was conducted using the faecal immunochemical test (FIT).

Several key indicators are used to assess the quality of colonoscopy and the effectiveness of colorectal cancer screening $5-9$, which reflect different aspects of the diagnostic process and the risk of subsequent malignant transformation (Table 1).

Table 1. Effectiveness indicators of colonoscopy in detecting colorectal lesions

Results and discussion

The first stage using the faecal immunochemical test identified 23.3% of individuals (n=256) with a positive result. Of these, 53.3% (n=136) underwent subsequent colonoscopy with clinical and, when neoplasms were detected, morphological evaluation, including the calculation of adenoma detection rate (ADR), advanced adenoma detection rate (AADR), and other parameters. The control group consisted of 204 patients, mean age 52.3 years, which allowed for a comparative analysis of indicators between different age groups.

Table 2. Diagnostic efficacy of colonoscopy in detecting colorectal lesions in different age groups

The ADR and AADR indicators were significantly higher in individuals over 50 years of age, confirming the feasibility of a personalized approach considering age (see Figure).

Fig. ADR, AADR and CRC by age group

It is important to note that no CRC cases were detected in the control group without faecal occult blood testing.

Adapting screening programs according to age groups and risk factors provides a more effective prevention strategy, reducing unnecessary invasive procedures without compromising diagnosis. This personalized approach positively impacts patient outcomes and quality of life.

Conclusion

The results of this study unequivocally confirm the high effectiveness of a personalized colorectal cancer screening program, based on the use of FIT followed by colonoscopy, among workers at an enterprise with increased hazardous conditions in the Yaroslavl region. The obtained data demonstrate a significant increase in the detection rates of precancerous and early cancerous lesions in individuals with increased occupational risk, indicating a significant potential for mortality reduction through the implementation of such programs.

Special attention should be paid to age stratification of patients, as ADR and AADR indicators significantly increase in the group of individuals over 50 years of age, which requires an adaptive approach to the frequency and methods of screening. The application of comprehensive, personalized screening, focused on detecting precancerous changes at early stages, is a strategically important element of the colorectal cancer prevention system and can significantly improve clinical outcomes through timely diagnosis and reduction in the prevalence of advanced stages of the disease.

The data from this study serve as a basis for implementing such an approach in regional healthcare programs, especially for individuals in groups with increased occupational and age-related risk of developing colorectal cancer.