Personalized colorectal cancer screening in high-risk groups

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.

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