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1Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
2Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
3Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
4Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
©2021, Korean Society of Epidemiology
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
The authors have no conflicts of interest to declare for this study.
FUNDING
This study was supported by a Grant-in-Aid for Cancer Research and Control from the National Cancer Center of Korea (#1910231).
AUTHOR CONTRIBUTIONS
Conceptualization: XQL, JK, DKS, AS, KSC. Formal analysis: XQL, KL. Funding acquisition: KSC. Methodology: XQL, KSC. Project administration: KL. Writing – original draft: XQL. Writing – review & editing: KSC, KL, JK, DKS, AS.
Risk factor | Criteria | Points |
---|---|---|
Age (yr) | <50 | 0 |
50-69 | 2 | |
≥70 | 3 | |
Sex | Female | 0 |
Male | 1 | |
Family history of colorectal cancer (first degree) | Yes | 0 |
No | 2 | |
Smoking | Non-smoker | 0 |
Current or ex-smoker | 1 |
Characteristics | Total (n=12,520) |
Colorectal risk level1 |
p-value2 | ||
---|---|---|---|---|---|
Average (n=2,687) | Moderate (n=6,071) | High (n=3,762) | |||
Sex | <0.001 | ||||
Male | 8,154 (65.1) | 2,084 (77.6) | 2,160 (35.6) | 122 (3.2) | |
Female | 4,366 (34.9) | 603 (22.4) | 3,911 (64.4) | 3,640 (96.8) | |
Age (yr) | <0.001 | ||||
<50 | 6,095 (48.7) | 2,687 (100) | 3,212 (52.9) | 196 (5.2) | |
50-59 | 4,505 (36.0) | 0 (0.0) | 1,985 (32.7) | 2,520 (67) | |
≥60 | 1,920 (15.3) | 0 (0.0) | 874 (14.4) | 1,046 (27.8) | <0.001 |
Mean±SD | 50.94±7.49 | 44.59±2.80 | 50.48±7.40 | 56.21±6.10 | |
Education level | <0.001 | ||||
Primary school or lower | 903 (7.2) | 63 (2.3) | 551 (9.1) | 289 (7.7) | |
Middle/high school | 5,284 (42.2) | 1,240 (46.2) | 2,499 (41.2) | 1,545 (41.1) | |
University or higher | 6,333 (50.6) | 1,384 (51.5) | 3,021 (49.8) | 1,928 (51.3) | |
Household monthly income (106 Korean won) | <0.001 | ||||
<2.00 | 1,560 (12.5) | 198 (7.4) | 813 (13.4) | 549 (14.6) | |
2.00-3.99 | 3,521 (28.1) | 696 (25.9) | 1,781 (29.3) | 1,044 (27.8) | |
≥4.00 | 7,439 (59.4) | 1,793 (66.7) | 3,477 (57.3) | 2,169 (57.7) | |
Comorbidity | <0.001 | ||||
No | 7,293 (58.2) | 2,101 (78.2) | 3,434 (56.6) | 1,758 (46.7) | |
Yes | 5,227(41.7) | 586 (21.8) | 2,637 (43.4) | 2,004 (53.3) | |
First-degree family history of CRC | <0.001 | ||||
No | 11,771 (94.0) | 2,687 (100) | 5,899 (97.2) | 3,185 (84.7) | |
Yes | 749 (6.0) | 0 (0.0) | 172 (2.8) | 577 (15.3) | |
Smoking status | <0.001 | ||||
Non-smoker | 5,588 (44.6) | 2,481 (92.3) | 2,901 (47.8) | 206 (5.5) | |
Ex-smoker | 1,641(13.1) | 28 (1.0) | 651 (10.7) | 962 (25.6) | |
Smoker | 5,291 (42.3) | 178 (6.6) | 2,519 (41.5) | 2,594 (69.0) | |
Alcohol drinking | <0.001 | ||||
Non-drinker/ex-drinker | 3,639 (29.1) | 1,029 (38.3) | 1,899 (31.3) | 711 (18.9) | |
Drinker | 8,881(70.9) | 1,658 (61.7) | 4,172 (68.7) | 3,051 (81.1) | |
BMI (kg/m2) | <0.001 | ||||
<23 | 4,405 (35.2) | 1,473 (54.8) | 1,916 (31.6) | 1,016 (27.0) | |
≥23 | 8,115 (64.8) | 1,214 (45.2) | 4,155 (68.4) | 2,746 (73.0) |
Variables | Total (n=12,520) |
Colorectal risk level1 |
p-value | ||
---|---|---|---|---|---|
Average (n=2,687) | Moderate (n=6,071) | High (n=3,760) | |||
Colorectal cancer | <0.001 | ||||
No | 12,410 (99.1) | 2,677 (99.6) | 6,024 (99.2) | 3,709 (98.6) | |
Yes | 110 (0.9) | 10 (0.4) | 47 (0.8) | 53 (1.4) | |
Advanced colorectal neoplasia2 | <0.001 | ||||
No | 12,203 (97.5) | 2,656 (98.8) | 5,937 (97.8) | 3,610 (96.0) | |
Yes | 317 (2.5) | 31 (1.1) | 134 (2.2) | 152 (4.0) | |
No. of polyps | <0.001 | ||||
0 | 7,003 (55.9) | 1,952 (72.6) | 3,495 (57.6) | 1,556 (41.4) | |
1 | 3,419 (27.3) | 573 (21.3) | 1,693 (27.9) | 1,153 (30.6) | |
≥2 | 2,098 (16.8) | 162 (6.0) | 883 (14.5) | 1,053 (28.0) | |
Adenoma | <0.001 | ||||
No | 8,814 (70.4) | 2,243 (83.5) | 4,413 (72.7) | 2,158 (57.4) | |
Yes | 3,706 (29.6) | 444 (16.5) | 1,658 (27.3) | 1,604 (42.6) |
Characteristics | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | NPV (95% CI) |
---|---|---|---|---|
Colorectal cancer | ||||
APCS1 | 0.48 (0.39, 0.58) | 0.70 (0.69, 0.71) | 0.01 (0.01, 0.02) | 0.99 (0.99, 0.99) |
APCS2 | 0.91 (0.85, 0.96) | 0.22 (0.21, 0.22) | 0.01 (0.01, 0.01) | 1.00 (0.99, 1.00) |
Screening guideline3 | 0.73 (0.64, 0.81) | 0.49 (0.48, 0.50) | 0.01 (0.01, 0.01) | 0.99 (0.99, 1.00) |
ACN | ||||
APCS1 | 0.48 (0.42, 0.54) | 0.70 (0.70, 0.71) | 0.04 (0.03, 0.05) | 0.98 (0.98, 0.98) |
APCS2 | 0.90 (0.87, 0.93) | 0.22 (0.21, 0.22) | 0.03 (0.03, 0.03) | 0.99 (0.98, 0.99) |
Screening guideline3 | 0.68 (0.63, 0.73) | 0.49 (0.48, 0.50) | 0.03 (0.03, 0.04) | 0.98 (0.98, 0.99) |
Adenoma | ||||
APCS1 | 0.43 (0.42, 0.45) | 0.75 (0.75, 0.76) | 0.43 (0.41, 0.44) | 0.76 (0.75, 0.77) |
APCS2 | 0.88 (0.87, 0.89) | 0.25 (0.24, 0.26) | 0.33 (0.32, 0.34) | 0.83 (0.82, 0.85) |
Screening guideline3 | 0.63 (0.62, 0.65) | 0.54 (0.53, 0.55) | 0.36 (0.35, 0.38) | 0.78 (0.77, 0.79) |
Multiple polyps | ||||
APCS1 | 0.50 (0.48, 0.52) | 0.74 (0.73, 0.75) | 0.72 (0.71, 0.73) | 0.88 (0.87, 0.89) |
APCS2 | 0.92 (0.91, 0.93) | 0.24 (0.23, 0.25) | 0.20 (0.19, 0.20) | 0.94 (0.93, 0.95) |
Screening guideline3 | 0.68 (0.66, 0.70) | 0.52 (0.51, 0.53) | 0.22 (0.21, 0.23) | 0.89 (0.88, 0.90) |
Variables |
Had ACN, n (%) |
Univariate OR (95% CI) |
Multivariate |
||
---|---|---|---|---|---|
No (n=12,203) | Yes (n=317) | Model 1 aOR (95% CI) | Model 2 aOR (95% CI) | ||
Colorectal risk level1 | |||||
Average | 2,656 (21.8) | 31 (9.8) | 1.00 (reference) | 1.00 (reference) | - |
Moderate | 5,937 (48.6) | 134 (42.3) | 1.93 (1.30, 2.87) | 1.72 (1.15, 2.57) | - |
High | 3,610 (29.6) | 152 (47.9) | 3.61 (2.44, 5.33) | 3.12 (2.08, 4.67) | - |
Sex | |||||
Female | 4,294 (35.2) | 72 (22.7) | 1.00 (reference) | - | 1.00 (reference) |
Male | 7,909 (64.8) | 245 (77.3) | 1.85 (1.42, 2.41) | - | 1.30 (0.89, 1.90) |
Age (yr) | |||||
<50 | 5,994 (49.1) | 101 (31.9) | 1.00 (reference) | 1.00 (reference) | |
50-59 | 4,387 (35.9) | 118 (37.2) | 1.60 (1.22, 2.09) | - | 1.54 (1.17, 2.02) |
≥60 | 1,822 (14.9) | 98 (30.9) | 3.19 (2.41, 4.24) | - | 3.00 (2.20, 4.08) |
First-degree family history of CRC | |||||
No | 11,479 (94.1) | 292 (92.1) | 1.00 (reference) | - | 1.00 (reference) |
Yes | 724 (5.9) | 25 (7.9) | 1.36 (0.90, 2.06) | - | 1.41 (0.93, 2.14) |
Smoking status | |||||
Non-smoker | 5,484 (44.9) | 104 (32.8) | 1.00 (reference) | - | 1.00 (reference) |
Ex-smoker/smoker | 6,719 (55.1) | 213 (67.2) | 1.67 (1.32, 2.12) | - | 1.42 (1.03, 1.97) |
Household monthly income (106 Korean won) | |||||
<2.00 | 1,499 (12.3) | 61 (19.2) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
2.00-3.99 | 3,438 (28.2) | 83 (26.2) | 0.59 (0.42, 0.83) | 0.63 (0.45, 0.88) | 0.71 (0.50, 1.01) |
≥4.00 | 7,266 (59.5) | 173 (54.6) | 0.59 (0.43, 0.79) | 0.63 (0.47, 0.85) | 0.75 (0.55, 1.03) |
Comorbidity | |||||
No | 7,132 (58.4) | 161 (50.8) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Yes | 5,071 (41.6) | 156 (49.2) | 1.36 (1.09, 1.70) | 1.11 (0.88, 1.39) | 1.04 (0.82, 1.31) |
Alcohol drinking | |||||
Non-drinker/ex-drinker | 3,557 (29.1) | 82 (25.9) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Drinker | 8,646 (70.8) | 235 (74.1) | 1.18 (0.91, 1.52) | 1.03 (0.79, 1.34) | 1.06 (0.80, 1.41) |
BMI (kg/m2) | |||||
<23 | 4,322 (35.4) | 83 (26.2) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
≥23 | 7,881 (64.6) | 234 (73.8) | 1.55 (1.20, 1.99) | 1.32 (1.02, 1.67) | 1.33 (1.03, 1.73) |
Risk factor | Criteria | Points |
---|---|---|
Age (yr) | <50 | 0 |
50-69 | 2 | |
≥70 | 3 | |
Sex | Female | 0 |
Male | 1 | |
Family history of colorectal cancer (first degree) | Yes | 0 |
No | 2 | |
Smoking | Non-smoker | 0 |
Current or ex-smoker | 1 |
Characteristics | Total (n=12,520) | Colorectal risk level |
p-value |
||
---|---|---|---|---|---|
Average (n=2,687) | Moderate (n=6,071) | High (n=3,762) | |||
Sex | <0.001 | ||||
Male | 8,154 (65.1) | 2,084 (77.6) | 2,160 (35.6) | 122 (3.2) | |
Female | 4,366 (34.9) | 603 (22.4) | 3,911 (64.4) | 3,640 (96.8) | |
Age (yr) | <0.001 | ||||
<50 | 6,095 (48.7) | 2,687 (100) | 3,212 (52.9) | 196 (5.2) | |
50-59 | 4,505 (36.0) | 0 (0.0) | 1,985 (32.7) | 2,520 (67) | |
≥60 | 1,920 (15.3) | 0 (0.0) | 874 (14.4) | 1,046 (27.8) | <0.001 |
Mean±SD | 50.94±7.49 | 44.59±2.80 | 50.48±7.40 | 56.21±6.10 | |
Education level | <0.001 | ||||
Primary school or lower | 903 (7.2) | 63 (2.3) | 551 (9.1) | 289 (7.7) | |
Middle/high school | 5,284 (42.2) | 1,240 (46.2) | 2,499 (41.2) | 1,545 (41.1) | |
University or higher | 6,333 (50.6) | 1,384 (51.5) | 3,021 (49.8) | 1,928 (51.3) | |
Household monthly income (106 Korean won) | <0.001 | ||||
<2.00 | 1,560 (12.5) | 198 (7.4) | 813 (13.4) | 549 (14.6) | |
2.00-3.99 | 3,521 (28.1) | 696 (25.9) | 1,781 (29.3) | 1,044 (27.8) | |
≥4.00 | 7,439 (59.4) | 1,793 (66.7) | 3,477 (57.3) | 2,169 (57.7) | |
Comorbidity | <0.001 | ||||
No | 7,293 (58.2) | 2,101 (78.2) | 3,434 (56.6) | 1,758 (46.7) | |
Yes | 5,227(41.7) | 586 (21.8) | 2,637 (43.4) | 2,004 (53.3) | |
First-degree family history of CRC | <0.001 | ||||
No | 11,771 (94.0) | 2,687 (100) | 5,899 (97.2) | 3,185 (84.7) | |
Yes | 749 (6.0) | 0 (0.0) | 172 (2.8) | 577 (15.3) | |
Smoking status | <0.001 | ||||
Non-smoker | 5,588 (44.6) | 2,481 (92.3) | 2,901 (47.8) | 206 (5.5) | |
Ex-smoker | 1,641(13.1) | 28 (1.0) | 651 (10.7) | 962 (25.6) | |
Smoker | 5,291 (42.3) | 178 (6.6) | 2,519 (41.5) | 2,594 (69.0) | |
Alcohol drinking | <0.001 | ||||
Non-drinker/ex-drinker | 3,639 (29.1) | 1,029 (38.3) | 1,899 (31.3) | 711 (18.9) | |
Drinker | 8,881(70.9) | 1,658 (61.7) | 4,172 (68.7) | 3,051 (81.1) | |
BMI (kg/m2) | <0.001 | ||||
<23 | 4,405 (35.2) | 1,473 (54.8) | 1,916 (31.6) | 1,016 (27.0) | |
≥23 | 8,115 (64.8) | 1,214 (45.2) | 4,155 (68.4) | 2,746 (73.0) |
Variables | Total (n=12,520) | Colorectal risk level |
p-value | ||
---|---|---|---|---|---|
Average (n=2,687) | Moderate (n=6,071) | High (n=3,760) | |||
Colorectal cancer | <0.001 | ||||
No | 12,410 (99.1) | 2,677 (99.6) | 6,024 (99.2) | 3,709 (98.6) | |
Yes | 110 (0.9) | 10 (0.4) | 47 (0.8) | 53 (1.4) | |
Advanced colorectal neoplasia |
<0.001 | ||||
No | 12,203 (97.5) | 2,656 (98.8) | 5,937 (97.8) | 3,610 (96.0) | |
Yes | 317 (2.5) | 31 (1.1) | 134 (2.2) | 152 (4.0) | |
No. of polyps | <0.001 | ||||
0 | 7,003 (55.9) | 1,952 (72.6) | 3,495 (57.6) | 1,556 (41.4) | |
1 | 3,419 (27.3) | 573 (21.3) | 1,693 (27.9) | 1,153 (30.6) | |
≥2 | 2,098 (16.8) | 162 (6.0) | 883 (14.5) | 1,053 (28.0) | |
Adenoma | <0.001 | ||||
No | 8,814 (70.4) | 2,243 (83.5) | 4,413 (72.7) | 2,158 (57.4) | |
Yes | 3,706 (29.6) | 444 (16.5) | 1,658 (27.3) | 1,604 (42.6) |
Characteristics | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | NPV (95% CI) |
---|---|---|---|---|
Colorectal cancer | ||||
APCS |
0.48 (0.39, 0.58) | 0.70 (0.69, 0.71) | 0.01 (0.01, 0.02) | 0.99 (0.99, 0.99) |
APCS |
0.91 (0.85, 0.96) | 0.22 (0.21, 0.22) | 0.01 (0.01, 0.01) | 1.00 (0.99, 1.00) |
Screening guideline |
0.73 (0.64, 0.81) | 0.49 (0.48, 0.50) | 0.01 (0.01, 0.01) | 0.99 (0.99, 1.00) |
ACN | ||||
APCS |
0.48 (0.42, 0.54) | 0.70 (0.70, 0.71) | 0.04 (0.03, 0.05) | 0.98 (0.98, 0.98) |
APCS |
0.90 (0.87, 0.93) | 0.22 (0.21, 0.22) | 0.03 (0.03, 0.03) | 0.99 (0.98, 0.99) |
Screening guideline |
0.68 (0.63, 0.73) | 0.49 (0.48, 0.50) | 0.03 (0.03, 0.04) | 0.98 (0.98, 0.99) |
Adenoma | ||||
APCS |
0.43 (0.42, 0.45) | 0.75 (0.75, 0.76) | 0.43 (0.41, 0.44) | 0.76 (0.75, 0.77) |
APCS |
0.88 (0.87, 0.89) | 0.25 (0.24, 0.26) | 0.33 (0.32, 0.34) | 0.83 (0.82, 0.85) |
Screening guideline |
0.63 (0.62, 0.65) | 0.54 (0.53, 0.55) | 0.36 (0.35, 0.38) | 0.78 (0.77, 0.79) |
Multiple polyps | ||||
APCS |
0.50 (0.48, 0.52) | 0.74 (0.73, 0.75) | 0.72 (0.71, 0.73) | 0.88 (0.87, 0.89) |
APCS |
0.92 (0.91, 0.93) | 0.24 (0.23, 0.25) | 0.20 (0.19, 0.20) | 0.94 (0.93, 0.95) |
Screening guideline |
0.68 (0.66, 0.70) | 0.52 (0.51, 0.53) | 0.22 (0.21, 0.23) | 0.89 (0.88, 0.90) |
Variables | Had ACN, n (%) |
Univariate OR (95% CI) | Multivariate |
||
---|---|---|---|---|---|
No (n=12,203) | Yes (n=317) | Model 1 aOR (95% CI) | Model 2 aOR (95% CI) | ||
Colorectal risk level |
|||||
Average | 2,656 (21.8) | 31 (9.8) | 1.00 (reference) | 1.00 (reference) | - |
Moderate | 5,937 (48.6) | 134 (42.3) | 1.93 (1.30, 2.87) | 1.72 (1.15, 2.57) | - |
High | 3,610 (29.6) | 152 (47.9) | 3.61 (2.44, 5.33) | 3.12 (2.08, 4.67) | - |
Sex | |||||
Female | 4,294 (35.2) | 72 (22.7) | 1.00 (reference) | - | 1.00 (reference) |
Male | 7,909 (64.8) | 245 (77.3) | 1.85 (1.42, 2.41) | - | 1.30 (0.89, 1.90) |
Age (yr) | |||||
<50 | 5,994 (49.1) | 101 (31.9) | 1.00 (reference) | 1.00 (reference) | |
50-59 | 4,387 (35.9) | 118 (37.2) | 1.60 (1.22, 2.09) | - | 1.54 (1.17, 2.02) |
≥60 | 1,822 (14.9) | 98 (30.9) | 3.19 (2.41, 4.24) | - | 3.00 (2.20, 4.08) |
First-degree family history of CRC | |||||
No | 11,479 (94.1) | 292 (92.1) | 1.00 (reference) | - | 1.00 (reference) |
Yes | 724 (5.9) | 25 (7.9) | 1.36 (0.90, 2.06) | - | 1.41 (0.93, 2.14) |
Smoking status | |||||
Non-smoker | 5,484 (44.9) | 104 (32.8) | 1.00 (reference) | - | 1.00 (reference) |
Ex-smoker/smoker | 6,719 (55.1) | 213 (67.2) | 1.67 (1.32, 2.12) | - | 1.42 (1.03, 1.97) |
Household monthly income (106 Korean won) | |||||
<2.00 | 1,499 (12.3) | 61 (19.2) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
2.00-3.99 | 3,438 (28.2) | 83 (26.2) | 0.59 (0.42, 0.83) | 0.63 (0.45, 0.88) | 0.71 (0.50, 1.01) |
≥4.00 | 7,266 (59.5) | 173 (54.6) | 0.59 (0.43, 0.79) | 0.63 (0.47, 0.85) | 0.75 (0.55, 1.03) |
Comorbidity | |||||
No | 7,132 (58.4) | 161 (50.8) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Yes | 5,071 (41.6) | 156 (49.2) | 1.36 (1.09, 1.70) | 1.11 (0.88, 1.39) | 1.04 (0.82, 1.31) |
Alcohol drinking | |||||
Non-drinker/ex-drinker | 3,557 (29.1) | 82 (25.9) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
Drinker | 8,646 (70.8) | 235 (74.1) | 1.18 (0.91, 1.52) | 1.03 (0.79, 1.34) | 1.06 (0.80, 1.41) |
BMI (kg/m2) | |||||
<23 | 4,322 (35.4) | 83 (26.2) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
≥23 | 7,881 (64.6) | 234 (73.8) | 1.55 (1.20, 1.99) | 1.32 (1.02, 1.67) | 1.33 (1.03, 1.73) |
Values are presented as number (%). SD, standard deviation; CRC, colorectal cancer; BMI, body mass index. Average-risk: 0-1; moderate-risk: 2-3; high-risk: 4-7. The chi-square test was used for categorical variables, and analysis of variance was used for comparing means.
Values are presented as number (%). Average-risk: 0-1; moderate-risk: 2-3; high-risk: 4-7. Advanced colorectal neoplasia cases were defined as either invasive cancer or advanced adenomas.
APCS, Asia-Pacific Colorectal Screening; ACN, advanced neoplasia; CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value. High-risk versus average/moderate-risk. High/moderate-risk versus average-risk. Aged 50 or older versus less than 50 years of age.
ACN, advanced colorectal neoplasia; CRC, colorectal cancer; BMI, body mass index OR, odd ratio; aOR, adjusted odd ratio; CI, confidence interval. Average-risk: 0-1; moderate-risk: 2-3; high-risk: 4-7.