A population-based randomized controlled trial for colorectal cancer screening in Khon Kaen, Thailand: Implementation and current situation

Pongdech Sarakarn,1,2, Patravoot Vatanasapt2,3, Chananya Jirapornkul1,2, Siriporn Kamsa-ard1,2, Naowarat Maneenin1,2, Supot Kamsa-ard1,2, Wongsane Khrueangchai4, Sam Li-Sheng Chen6, Amy Ming-Fang Yen6, Sherry Yueh-Hsia7, Jean Ching-Yuan Fann8, Tony Hsiu-Hsi Chen5

1Epidemiology and Biostatistics Department, Faculty of Public Health, Khon Kaen University, Thailand
2ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Thailand

3Department of Surgery, Faculty of Medicine, Khon Kaen University, Thailand
4Nam Phong District Public Health Office, Khon Kaen Province, Thailand
5Institute of Epidemiology and Prevention Medicine, College of Public Health, National Taiwan University, Taiwan
6College of Oral Medicine, School of Oral Hygiene, Taipei Medical University, Taiwan
7Department of Health Care Management, College of Management, Chang Gung University, Taiwan
8Department of Health Industry Management, School of Healthcare Management, Kainan University, Taiwan

Background: In Thailand, colorectal cancer (CRC) is one of the five most common cancers and incidence trend of CRC is gradually increasing in both sexes. Previous studies showed that CRC can be prevented by screening, but the national CRC screening is not conducted in the whole country of Thailand. Some knowledges and experiences of CRC screening based on the population-based screening in the small scale should be considered.       

Methods: A population-based randomized controlled trial for CRC screening was conducted and began in May, 2016. All people aged 45 to 74 years living in Nam Phong District, Khon Kaen Province, Thailand, and willing to participate are being recruited using an invitation letter. Enrolled participants are randomly allocated by a computer-generated randomization program either to a study arm (receive sample kit for Fecal Immunochemical Test-FIT) or to a control arm (no provision of kit). Positive FIT cases are subsequently confirmed by a colonoscopy examination, and negative FIT cases are re-tested with FIT every two years. Some issues were analyzed using various statistics.

Results: A total of 3,371 enrolled participants provided a complete set of data for each arm. Of those randomly assigned to the study arm and completed for testing by FIT (3,180, 94.3%), 237 (7.45%) were found to be positive, 102 (43.04%) males and 135 (56.96%) females. We found that awareness of CRC screening of both arms is still low, while the f-Hb concentrations at the different value can be related with several variables which is important to consider and study for insight, including sex, aged groups and hypertension.  

Conclusions: Both awareness and f-Hb concentrations will be considered to think over for implementation regarding several activities to do for intervention and to study for insight, especially the relationship of f-Hb concentration among sex, aged groups, and related non-communicable disease (NCD).  

Keywords: colorectal cancer screening, fecal immunochemical test, Thailand