The performance of a community-based colorectal cancer screening program: Evidence from Shanghai Pudong New Area, China

Despite the rising disease burden of colorectal cancer (CRC), CRC screening has not yet been widely introduced as a large organized program in developing countries. To facilitate better delivery of screening in these areas, we investigated the performance of a large community-based CRC screening program implemented in Shanghai Pudong New Area during the period 2013-2016. We conducted a prospective cohort study by following up the screening behavior and results of tested participants in the program. Data from the program reporting system and monthly progress reports were collected. We used standard measures and indicators with modifications to evaluate the performance of the program. Disparities in CRC screening by age categories, primary screening results, and geographic areas were examined. A total of 403,098 individuals participated in the program, 25,764 of them were further screened by diagnostic colonoscopy (COL), and 505 people were eventually diagnosed with CRC as a result of the program. The program produced the following rates: participation (35.18%), primary screening positivity (24.89%), positive primary screening follow-up (26.26%), diagnostic COL (6.37%), and cancer detection (1.25%0). Vast variations in the quality of the program were observed across areas with different socioeconomic environments. The experience and lessons from the program suggest that incorporating the screening with other public health campaigns, using better-developed risk assessment tools, and allowing individual screening decisions for those aged above the target are possible practical ways to promote a better delivery of organized CRC screening programs.