Завьялов Дмитрий Вячеславович - д. м. н., доцент кафедры онкологии с гематологией
Ярославль
Dmitry V. Zavyalov - Dr. Sci. (Med.), Associate Professor of the Department oncology
Yaroslavl
Крюков Кирилл Андреевич - аспирант кафедры онкологии с гематологией
Ярославль
Kirill A. Kryukov - graduate student of the Department oncology
Yaroslavl
Мельникова Екатерина Владимировна - к. м. н., зам. генерального директора по научной работе
Ярославль
Ekaterina V. Melnikova - Cand. Sci. (Med), Deputy Director for Research, Medical Center for Diagnostics and Prevention
Yaroslavl
Relevance. Colorectal cancer (CRC) is one of the most common and lethal oncological diseases in Russia. The Yaroslavl region is experiencing a steady increase in incidence, including an alarming trend of rising CRC cases among individuals under 50 years of age (a 56.3 % increase). This underscores the need to develop and implement effective, targeted screening programs, especially for high-risk groups, such as workers in hazardous industries.Objective. To evaluate the effectiveness of a personalized colorectal cancer screening program based on a two-stage method (faecal immunochemical test (FIT) followed by colonoscopy) among workers at an industrial enterprise with increased occupational hazards in the Yaroslavl region.Materials and methods. The study cohort included 1,105 employees of the "YANOS" industrial enterprise aged 38 years and older, classified as a high-risk group for CRC development due to exposure to chemical and physical occupational hazards. Screening was conducted in two stages: I stage — Initial testing using FIT; II stage — colonoscopy for individuals with a positive FIT result (n=136). A set of validated colonoscopy quality indicators was used to assess effectiveness: adenoma detection rate (ADR), advanced adenoma detection rate (AADR), serrated lesion detection rate (SSLR), polyp detection rate (PDR), adenomas per colonoscopy (APC), adenomas per positive patient (APPP), and CRC (colorectal cancer detection rate). A control group of 204 patients was included for comparison.Results. Based on the FIT results, 23.3 % (256 individuals) of all participants tested positive. Overall effectiveness indicators were significantly higher in the FIT-positive group who underwent colonoscopy (n = 136) than in the control group: ADR was 32.4 % vs. 18.1 %, AADR was 27.9 % vs. 18.6 %, and PDR was 50.7 % vs. 37.3 %, respectively. A clear age dependence was identified: in the ≥50 years group, ADR (37.0 %) and AADR (34.5 %) rates were significantly higher than in the <50 years group (25.0 % and 17.3 %, respectively). Key finding: colorectal cancer was diagnosed in 3.7 % of cases in the FIT-positive group (1.9 % in the <50 years group and 4.8 % in the ≥50 years group), whereas no cancer cases were detected in the control group.Conclusions. The personalized two-stage screening program (FIT + colonoscopy) demonstrated high effectiveness for the early detection of precancerous lesions and CRC among workers with occupational risks. Age is a critically important factor: adenoma and advanced adenoma detection rates (ADR, AADR) significantly increase after age 50, confirming the need for age stratification and adaptation of screening intervals. Implementing such targeted programs in regional healthcare systems, especially for high-risk groups (occupational and age-related), is strategically important for reducing CRC mortality through early diagnosis and prevention.
Актуальность. Колоректальный рак (КРР) является одним из наиболее распространённых и летальных онкологических заболеваний в России. В Ярославской области отмечается устойчивый рост заболеваемости, включая тревожную тенденцию к увеличению числа случаев КРР среди лиц моложе 50 лет (прирост 56,3 %). Это подчёркивает необходимость разработки и внедрения эффективных, целенаправленных скрининговых программ, особенно для групп повышенного риска, таких как работники вредных производств.Цель. Оценка эффективности персонализированной программы скрининга колоректального рака, основанной на двухэтапном методе (иммунохимический тест на скрытую кровь в кале (FIT) с последующей колоноскопией), среди работников промышленного предприятия с повышенными профессиональными вредностями в Ярославской области.Материалы и методы. В исследование была включена когорта из 1105 сотрудников промышленного предприятия «ЯНОС» в возрасте от 38 лет и старше, отнесённых к группе повышенного риска развития КРР благодаря воздействию химических и физических профессиональных вредностей. Скрининг проводился в два этапа: I этап — первичное тестирование с помощью FIT; II этап — колоноскопия для лиц с положительным результатом FIT (n=136). Для оценки эффективности использовался набор валидированных показателей качества колоноскопии: ADR (процент выявления аденом), AADR (процент выявления аденом высокого риска), SSLR (частота зубчатых новообразований), PDR (процент выявления полипов), APC (среднее число аденом на процедуру), APPP (среднее число аденом на положительного пациента), CRC (процент выявленного рака). Контрольную группу составили 204 пациента.Результаты. По результатам FIT, положительными оказались 23,3 % (256 человек) от общего числа участников. В FIT-позитивной группе, прошедшей колоноскопию (n=136), общие показатели эффективности были существенно выше, чем в контрольной группе: ADR составил 32,4 против 18,1 %, AADR — 27,9 % против 18,6 %, PDR — 50,7 % против 37,3 %. Выявлена чёткая возрастная зависимость: в группе ≥50 лет показатели ADR (37,0 %) и AADR (34,5 %) были значительно выше, чем в группе <50 лет (25,0 и 17,3 % соответственно). Ключевой результат: в FIT-позитивной группе был диагностирован колоректальный рак в 3,7 % случаев (1,9 в группе <50 лет и 4,8 % в группе ≥50 лет), в то время как в контрольной группе случаев рака выявлено не было.Выводы. Персонализированная двухэтапная программа скрининга (FIT + колоноскопия) демонстрирует высокую эффективность для раннего выявления предраковых поражений и колоректального рака среди работников с профессиональными рисками. Возраст является критически важным фактором: показатели выявления аденом и аденом высокого риска (ADR, AADR) значительно возрастают после 50 лет, что подтверждает необходимость возрастной стратификации и адаптации скрининговых интервалов. Внедрение подобных целевых программ в региональные системы здравоохранения, особенно для групп повышенного риска (профессионального и возрастного), является стратегически важным для снижения смертности от КРР за счёт ранней диагностики и профилактики.
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% 11. 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 2−42−4.
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 5−95−9, 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
IndicatorDescriptionADR (adenoma detection rate)Percentage of colonoscopies where at least one adenoma is detected. A key marker of procedure quality and CRC risk reduction.AADR (advanced adenoma detection rate)Percentage of colonoscopies with adenomas having a high risk of malignancy (large size or severe dysplasia). Important for assessing oncological risk.SSLR (serrated lesion rate)Frequency of detecting serrated lesions.PDR (polyp detection rate)Percentage of colonoscopies with detected polyps of all types, including adenomas. Helps assess the completeness of the examination.APC (adenomas per colonoscopy)Average number of adenomas detected per procedure, reflects the quality of the examination.APPP (adenomas per positive patient)Average number of adenomas in a patient with at least one adenoma.CRC (colorectal cancer detection rate)Percentage of colonoscopies with diagnosed cancer, reflecting the effectiveness of early detection.
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
Quality IndicatorsFIT-Positive GroupControl Group <50 yrs (n=52)≥50 yrs (n=84)Total (n=136)<50 yrs (n=108)≥50 yrs (n=96)Total (n=204)ADR25.0%37.0%32.4%11.1%26.0%18.1%AADR17.3%34.5%27.9%11.1%27.0%18.6%SSLR21.2%27.4%25.0%22.2%20.8%21.6%PDR48.1%52.4%50.7%37%37.5%37.3%APC0.270.560.450.130.310.22APPP1.081.521.391.171.201.18CRC1.9%4.8%3.7%0%0%0%
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.
The authors declare that there are no conflicts of interest present.