Long-term effectiveness of a two-step colorectal cancer screening strategy and risk of colorectal cancer after polypectomy.

Authors

Lijuan Dai, Le Wang, Yunfeng Zhu, Furong Chang, Weiwei Chen, Xueni Cheng, Yuefan Shen, Meng Zhu, Hongxia Ma, Guangfu Jin, Zhibin Hu, Lingbin Du, Dong Hang, Hongbing Shen

Published in

Chinese journal of cancer research = Chung-kuo yen cheng yen chiu. Volume 38. Issue 4. Pages 519-532. Aug 30, 2026.

Abstract

This study aimed to evaluate the long-term effectiveness of a colorectal cancer (CRC) screening strategy combining fecal immunochemical testing (FIT) and questionnaire-based risk assessment (QRA), and to characterize post-polypectomy CRC risk within this screening framework.
A total of 295,706 participants who underwent FIT or QRA were enrolled in a CRC screening program in China. Those with positive results were classified as high risk and referred for colonoscopy. Absolute risk reductions (ARRs) and numbers needed to screen (NNS) were estimated for CRC incidence and mortality. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs), compared to low-risk non-attenders. Among participants with polyps, post-polypectomy CRC risk was evaluated by comparing index colonoscopy findings with negative findings.
During a median follow-up of 11.41 years, 1,267 CRC cases and 387 CRC-specific deaths were identified. Among high-risk individuals, colonoscopy attendance was associated with 10-year ARRs of 0.83% for CRC incidence and 0.31% for CRC mortality, corresponding to NNS values of 121 and 323, respectively. Compared with low-risk colonoscopy non-attenders, high-risk colonoscopy attenders showed no significantly increased CRC incidence over 15 years and had lower CRC-specific mortality at 10 and 15 years, with HRs of 0.59 (95% CI: 0.36-0.97) and 0.57 (95% CI: 0.37-0.88), respectively. In contrast, high-risk colonoscopy non-attenders had markedly increased risks of both CRC incidence (HR=2.79, 95% CI: 2.39-3.25) and mortality (HR=2.82, 95% CI: 2.14-3.71). Individuals with high-risk polyps had a markedly elevated CRC risk as early as 3 years after index colonoscopy (HR=5.75, 95% CI: 1.90-17.36).
Within a two-step FIT-QRA screening strategy, colonoscopy attendance among high-risk individuals was associated with long-term benefit and a risk profile closer to that of the low-risk population, whereas individuals with high-risk polyps showed markedly elevated CRC risk from 3 years after polypectomy.

PMID:
42713179
Bibliographic data and abstract were imported from PubMed on 09 Sep 2026.

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