Colorectal cancer screening based on fecal immunochemical test and risk assessment: a population-based study including two million participants in China

The fecal immunochemical test (FIT) has been widely used in colorectal cancer (CRC) screening, yet the practical performance of FIT combined with questionnaire-based risk assessment (QRA) remains undetermined. Moreover, risk factors for distinct CRC precursors identified in screening have been rarely compared. This study was based on a population-based CRC screening in China, with 2,120,340 participants completing both FIT and QRA. Those with positive FIT or high QRA scores were recommended for colonoscopy. We reported the compliance, detection rate, and colonoscopy workload according to FIT and QRA results. We also explored risk factors for conventional adenomas and serrated polyps. The compliance rate of colonoscopy in the subgroup of FIT (+) and QRA (+) was 41.4%, higher than the rates in FIT (+) and QRA (-), as well as FIT (-) and QRA (+), which were 38.7% (P