From community screening to treatment follow-up: a three-year real-world evaluation of a colorectal cancer screening-to-care pathway under an integrated medical consortium model in Southern Jiangsu, China
This three-year real-world evaluation of a colorectal cancer screening-to-care pathway in Southern Jiangsu, China, demonstrates that while the integrated medical consortium model achieved high diagnostic yields and strong treatment completion rates, the primary bottleneck remains the transition from positive initial screening results to diagnostic colonoscopy.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine a massive, invisible maze hidden inside the human body, where tiny, sneaky traps called polyps can slowly grow into something much more dangerous over time. This is the world of colorectal cancer, a common health challenge that doesn't just happen overnight; it starts small and quiet. For a long time, doctors have known that if you can catch these traps early, before they turn into a full-blown crisis, you can often stop them completely. But here's the tricky part: finding them isn't like spotting a lost key on a sidewalk. It requires a special, multi-step journey. First, you need a simple "smoke detector" test to see if something might be wrong. If that test beeps, you need a more serious, detailed look inside using a camera on a flexible tube (a colonoscopy). Finally, if the camera finds a trap, you need to remove it and make sure the person gets the care they need to stay safe. The big question for scientists isn't just "Can we find the smoke?" but "Do we have a working fire truck that actually gets to the fire, puts it out, and checks that the house is safe afterward?"
This is exactly what a team of researchers in Southern Jiangsu, China, set out to investigate. They looked at a three-year program (from 2023 to 2025) where four different neighborhoods worked together with a big hospital to run this entire "screening-to-care" journey. Think of it like a relay race where the community health centers pass the baton to the hospital, and the hospital passes it back to the community for follow-up. They wanted to see if this teamwork actually worked in the real world, or if people dropped the baton somewhere along the track.
The researchers gathered data on over 10,000 initial records, which they cleaned up to find 9,516 unique people who actually showed up for screening. These were mostly adults with an average age of 62.1 years. The process started with two simple checks: a questionnaire about their health history (like family history or smoking) and a stool test to look for hidden blood. Out of the people who got the stool test, 6.2% had a positive result, meaning the "smoke detector" went off. Meanwhile, the health questionnaires flagged 27.2% of people as "high-risk."
Here is where the relay race hit a major pothole. The researchers estimated that about 3,311 people should have gone on to the next step: the colonoscopy. However, only 925 people actually made it to the exam. That means the "colonoscopy compliance" rate was only 27.9%. In other words, for every four people who were told they might need a closer look, only one actually got the camera check. This was the biggest drop-off in the entire process.
But for the people who did make it to the colonoscopy, the story was much brighter. The doctors did a great job with the exams themselves. They successfully reached the very end of the colon (the cecum) in 93.0% of cases, and the bowel preparation was good enough in 85.5% of cases. Because the exams were high-quality, they found a lot of trouble spots: 46.4% of the people had adenomas (the precancerous traps), 18.3% had advanced adenomas (the bigger, more dangerous ones), and 4.2% had high-risk neoplasia, which includes cancer or very severe pre-cancer.
Once these serious issues were found, the team's teamwork really shined. Of the 173 patients who needed timely treatment, 154 of them completed their treatment. That's a success rate of 89.0%. The researchers noticed that this treatment completion rate jumped up significantly in 2024 and 2025, reaching nearly 98%, suggesting that the system got better at keeping people on track once they were in the hospital.
So, what's the final verdict? The study suggests that the "integrated medical consortium" model—where community centers and hospitals work as one team—is excellent at finding high-risk people and getting them treated once they are in the system. The "fire truck" works perfectly once it arrives at the scene. However, the biggest weakness is getting the people to the scene in the first place. The transition from a positive test result to actually getting the colonoscopy is where the program is currently failing, with about 72% of eligible people not making the appointment. The authors conclude that while the system is great at diagnosis and treatment, the next big challenge is figuring out how to convince and help those high-risk residents to actually show up for their exams. They didn't prove that the current system is perfect, but they did measure exactly where the cracks are, showing that the real work lies in bridging the gap between "you might be at risk" and "let's take a look."
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