Organizational and management model of colorectal cancer screening with an integrated questionnaire method: results of a pilot project in the Russia

AIM: to evaluate the effectiveness of an organizational and managerial model for CRC screening based on the integration of questionnaire for primary risk stratification and relevant systemic solutions.

PATIENTS AND METHODS: the pilot CRC screening project involved 960 patients — employees of industrial and educational institutions. The organizational and managerial model algorithm included: coordination and monitoring, work with project participants, controlled quality at all stages, identification of “anchor” medical organizations, and interdisciplinary interaction via telemedicine technologies. Participant stratification for subsequent colonoscopy was performed using an original questionnaire developed by the staff of the National Medical Research Center for Coloproctology. For comparative analysis, a quantitative faecal immunochemical test (FIT) was also used in all cases.

RESULTS: after educational lectures, 872 (90.8%) respondents expressed willingness to further participation in the screening program. Of the 280 individuals invited to the second stage, 164 participants (58.6%) consented to participate. All second-stage participants (n = 164) underwent colonoscopy. Indications for deep checkup were present in 127 out of 164 individuals (77.4%). Indications were high risk according to the questionnaire (n = 100), positive FIT result (n = 34). In 7 patients, a combination of positive results was detected for both stratification methods. The remaining 37 out of 164 participants (22.6%) had no formal indications for colonoscopy (negative FIT and low risk according to the questionnaire) and underwent the examination at their own request. According to colonoscopy findings, neoplasms were detected in 95 out of 164 cases (57.9%) (malignant in 2.4%, benign in 55.5%). For the questionnaire method, sensitivity was 73.7% (95% CI: 63.6–82.2), and specificity was 56.5% (95% CI: 44.0–68.4). For the faecal immunochemical test (FIT), sensitivity was 24.2% (95% CI: 16.0–34.1), and specificity was 84.1% (95% CI: 73.3–91.8). As an independent stratification method, the questionnaire identified 3 out of 4 cases of malignant neoplasms (75.0%), whereas FIT identified 2 out of 4 cases (50.0%). The most significant advantage of the questionnaire was demonstrated in the context of secondary prevention of colorectal cancer. Using the questionnaire, polyps were diagnosed in 67 out of 91 patients (73.6%), while FIT detected polyps in only 21 out of 91 patients (23.1%), p < 0.001. In 5 patients (5.5%), positive results were found for both methods. Additionally, in 8 patients with benign neoplasms who underwent colonoscopy at their request, stratification results were negative (low risk according to the questionnaire and negative FIT).

CONCLUSION: the implementation of a combination of widely available primary risk stratification tools (questionnaire) and high-tech solutions (artificial intelligence for endoscopic data analysis) will optimize the approach to screening programs for large populations and enhance their effectiveness.

1. Partyka O, Pajewska M, Czerw A, et al. Current Progress in Clinical Research in Secondary Prevention and Early Detection of Colorectal Cancer. Cancers. 2025;17(3):367. doi: 10.3390/cancers17030367

2. Kaprin A.D., Starinsky V.V., Shachzadova A.O., et al. Malignant neoplasms in Russia in 2024 (morbidity and mortality). Moscow: P.A. Herzen Moscow State Medical Research Institute. 2025; 178 p. (In Russ.)

3. Duarte RB, Bernardo WM, Sakai CM, et al. Computed tomography colonography versus colonoscopy for the diagnosis of colorectal cancer: a systematic review and meta-analysis. Ther Clin Risk Manag. 2018;14:349–360. doi: 10.2147/TCRM.S152147

4. Order of the Ministry of Health of the Russian Federation No. 404n dated April 27, 2021 “On Approval of the Procedure for preventive medical examination and medical examination of certain groups of the adult population”. The link is active on 12/30/25. (Accessed: 31 December 2025). (In Russ.) http://publication.pravo.gov.ru/Document/View/0001202106300043

5. Kulovskaya D.P., Shelygin Y.A., Frolov S.A., et al. Validation of the risk questionnaire for colorectal cancer detection. Koloproktologia. 2023;22(3):76– 84. (In Russ.). doi: 10.33878/2073-7556-2023-22-3-76-84

6. Achkasov S.I., Shelygin Y.A., Frolov S.A., et al. Approbation of a risk-associated colorectal cancer screening model in a population. Preliminary results. Corporate Health and Industrial Medcine. 2024;1(1):31–41. (In Russ.).

7. Shelygin Y.A., et al. Clinical guidelines. Polyp of the colon and rectum (K62.1, K63.5, D37.4, D12.0, D12.1, D12.2, D12.3, D12.4, D12.5, D12.6, D12.7, D12.8), adults, children (project). Koloproktologia. 2025;24(4):11–45. (in Russ.). doi: 10.33878/2073-7556-2025-24-4-11-45

8. Johnson DA, Barkun AN, Cohen LB, et al. US Multi-Society Task Force on Colorectal Cancer. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Gastroenterology. 2014;147:903–924. doi: 10.1053/j.gastro.2014.07.002

9. Radaelli F, Meucci G, Sgroi G, et al. Italian Association of Hospital Gastroenterologists (AIGO) Technical performance of colonoscopy: the key role of sedation/analgesia and other quality indicators. Am J Gastroenterol. 2008;103:1122–1130. doi: 10.1111/j.1572-0241.2007.01778.x

10. Lee TJ, Rutter MD, Blanks RG, et al. Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme. Gut. 2012;61:1050–1057. doi: 10.1136/gutjnl-2011-300651

11. Shahini E, Sinagra E, Vitello A, et al. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature. World J Gastroenterol. 2023 Mar 21;29(11):1685–1707. doi: 10.3748/wjg.v29.i11.1685

12. Kulovskaya D.P., Achkasov S.I., Shelygin Y.A., et al. Comparative assessment of questionnaire and fecal immunochemical test efficacy in colorectal cancer screening. Khirurg (Surgeon). 2022; (4): 31–40. (in Russ.). doi: 10.33920/med-15-2204-04

13. Achkasov S.I., Shelygin Y.A., Shabunin A.V., et al. Efficiency of the ARTINCOL artificial intelligence system in diagnosing neoplasms during colonoscopy: results of a multicenter randomized study. Koloproktologia. 2025;24(3):12–21. doi: 10.33878/20737556-2025-24-3-12-21