An Exploratory Study Of Early Bowel Cancer Screening Among First-degree Relatives And Spouses Of Colorectal Cancer Patients

BACKGROUND: Strengthening cancer early screening is an important deployment in the "Healthy China 2030" plan,and it is also the best way to improve the survival rate of cancer patients.With the improvement of people’s living standard and the change of life style or environment,the incidence and mortality of colorectal cancer,CRC)in the world and China remain high.Therefore,in recent years,more and more attention has been paid to early screening of colorectal cancer,and various methods of early screening of colorectal cancer have emerged.With the special support of the sustainable development of Shenzhen Science and Technology Commission,our research group launched a non-invasive early screening public welfare project for colorectal cancer in Shenzhen in conjunction with a number of units.At present,the project is in progress,and this study only carries out phased summary analysis on the data of some high-risk groups.Methods: The included population were the first-degree relatives and spouses of patients with colorectal cancer or advanced adenoma who were diagnosed in the oncology department of Peking University Shenzhen Hospital from October 2019 to November 2022.With the informed consent of the subjects,each subject filled out a questionnaire as required,and collected a certain amount of stool samples and peripheral blood samples at the same time.After corresponding treatment,fecal samples were detected by immunochemistry(FIT)and DNA-m of fecal occult blood,and blood samples were detected by tumor markers CEA,CA199 and REG1 A.According to the results of the joint detection of feces and peripheral blood,the project team stratified the screening risk(extremely high risk,high risk,medium risk and low risk)and recommended the classification of subsequent colonoscopy(classified into A,B,C and D according to the recommended grades),and analyzed the detection rate of intestinal lesions and the high-risk patients diagnosed in the population after different stratified classification,so as to explore the predictive efficiency of the combined detection combination.Results: 1)A total of 261 first-degree relatives(128 males and 133 females,with a median age of 53 years)and 177 spouses(85 males and92 females,with a median age of 58.5 years)from 152 patients with colorectal cancer were included in this study.2)Among the firstdegree relatives,8 cases were positive for FIT(3.1%),26 cases were positive for DNA-m(10%)and 86 cases were positive for tumor markers(3.3%),among which 103 cases were positive for either method(medium risk,39.5%),and 8 cases were positive for either method(high risk,high risk)A total of 65 subjects underwent colonoscopy,and 1 case of colon cancer,12 cases of advanced adenoma,34 cases of intestinal polyps and 22 cases of intestinal inflammation were diagnosed.3)Among the spouses,12 cases were positive for FIT(6.8%),24 cases were positive for DNA-m(13.6%)and 52 cases were positive for tumor markers(29.4%).Among them,76 cases were positive for either method(medium risk,43.0%)and 6 cases were positive for either method(high risk,3.4%).A total of 48 subjects underwent colonoscopy,and1 case of colon cancer,16 cases of advanced adenoma,18 cases of intestinal polyps and 10 cases of intestinal inflammation were diagnosed.4)Nearly half of all the participants did not follow the advice to receive colonoscopy.Among the 13 cases of colon cancer and advanced adenoma diagnosed by colonoscopy in first-degree relatives,2 cases showed positive results of two detection methods in noninvasive early screening(high risk),and 11 cases showed positive results of either detection method in noninvasive early screening(medium risk);Among the 17 patients whose spouses were diagnosed with colon cancer and advanced adenoma by colonoscopy,3 cases showed positive results of two detection methods(high risk)in noninvasive early screening,and 14 cases showed positive results of either detection method(medium risk)in noninvasive early screening.Conclusion: It is very necessary for the first-degree relatives and spouses of patients with colorectal cancer or advanced adenoma to carry out non-invasive early screening of colorectal cancer.All three methods explored in this study can be used for early screening of colorectal cancer,and the efficiency of multiple methods combined with early screening has a trend of improvement compared with that of single method.However,due to the small sample size included in this study,the specific prediction efficiency is inconclusive,which needs to be reported in subsequent large sample results.In addition,it is suggested that the subjects should be further examined by colonoscopy for people with medium and high risk found in noninvasive early screening.