Findings from the first colorectal cancer screening among 103,542 individuals in Vietnam with systematic review of colorectal cancer screening programs in the Asia-Pacific region

Abstract

Abstract Background: Colorectal cancer is a leading cancer incidence and cause of death worldwide and in Vietnam. Although screening is considered an effective measure to prevent and control colorectal cancer, there is no such effort in Vietnam. Methods: Between 01 January 2018 and 31 October 2019, a population-based colorectal cancer screening program was conducted in Hanoi, Vietnam. A health advocacy campaign and follow-up phone calls were used to enroll residents aged ≥40 years old to complete an immunochemical-fecal occult blood testing. Positive immunochemical-fecal occult blood testing was followed by a colonoscopy. We also conducted a systematic review of the colorectal cancer screening programs in the Asia-Pacific region that used a similar approach by searching Ovid Medline and PubMed databases. Results: During the study period, 103,542 individuals among 672,742 eligible residents attended the screening, of whom 81.5% participants finished the immunochemical-fecal occult blood testing test, and the positive rate was 6.1%. The coverage rate for immunochemical-fecal occult blood testing was 11.9%. Among 2,278 individuals who underwent colonoscopy, 3.5% were histologically diagnosed with cancer, 17.8% with advanced adenomas, and 23.1% with non-advanced adenomas. Males had significantly higher detection rates of advanced adenomas, cancer, or ≥ two polyps/tumors than females (P < 0.0001). The systematic review showed that in the two-step modality (i.e., immunochemical-fecal occult blood testing/fecal immunochemical test and colonoscopy), the test positive rate was from 4.1 to 10.6%. Once colonoscopy was performed subsequently, the rate of cancer among positive participants was from 1.7 to 16.4%, and that of advanced adenomas was from 7.1 to 23.1%. Conclusion: We showed that the two-step modality is a promising strategy for colorectal cancer screening in Vietnam that might apply to similar settings with limited resources.