{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:11:36Z","timestamp":1790079096494,"version":"4.0.1"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72574131"],"award-info":[{"award-number":["72574131"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2026,11,15]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Colorectal cancer (CRC) screening reduces disease burden, but the comparative performance of various screening strategies remains unclear. We evaluated the performance of four screening strategies based on questionnaire\u2010based risk assessment (QRA) and fecal immunochemical test (FIT), followed by colonoscopy. In this population\u2010based study, 14,327 residents aged 40\u201374\u2009years from 13 regions in Shandong Province, China, were invited to undergo QRA, FIT, and colonoscopy between January 2024 and December 2025. Based on test results, we constructed four strategies: QRA\u2010only, FIT\u2010only, parallel (QRA or FIT positive), and tandem (QRA and FIT positive) combinations. The detection rate of CRC and advanced adenoma (AA), number needed to scope (NNS), and cost per case detected were compared. In total, 4982, 1806, 5970, and 764 individuals were identified as high\u2010risk for each strategy. The tandem strategy detected 33 CRCs (4.32%) and 199 AAs (26.03%), compared with 35 (0.71%) and 553 (11.22%) in the QRA\u2010only strategy, 68 (3.77%) and 340 (18.86%) in the FIT\u2010only strategy, and 70 (1.17%) and 694 (11.62%) in the parallel strategy. Across subgroups defined by older age, male, and early\u2010stage disease, the tandem strategy consistently yielded higher detection rates. The NNS to detect one CRC was 141, 27, 86, and 24, and the corresponding costs per CRC detected were $9874.31, $2097.88, $7084.68, and $1700.71 for each strategy. The tandem strategy combining QRA and FIT demonstrated superior performance in CRC screening. In resource\u2010constrained settings, tandem strategies that jointly integrate risk assessment and FIT may improve the allocation and utilization of screening resources.<\/jats:p>","DOI":"10.1002\/ijc.70610","type":"journal-article","created":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T04:17:53Z","timestamp":1781929073000},"page":"2421-2430","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Can the Parallel or Tandem Combination of Questionnaire\u2010Based Risk Assessment and Fecal Immunochemical Test Improve the Efficiency of Colorectal\u00a0Cancer Screening?"],"prefix":"10.1002","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6122-7733","authenticated-orcid":false,"given":"Ruyue","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine Shandong University  Jinan China"},{"name":"NHC Key Lab of Health Economics and Policy Research (Shandong University)  Jinan China"},{"name":"Center for Health Management and Policy Research Shandong University (Shandong Provincial Key New Think Tank)  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyi","family":"Ji","sequence":"additional","affiliation":[{"name":"School of Public Health Shandong Second Medical University  Weifang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Wei","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health University of Toronto  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Zheng","sequence":"additional","affiliation":[{"name":"Shandong Provincial Third Hospital, Cheeloo College of Medicine Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine Shandong University  Jinan China"},{"name":"Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Sun","sequence":"additional","affiliation":[{"name":"NHC Key Lab of Health Economics and Policy Research (Shandong University)  Jinan China"},{"name":"Center for Health Management and Policy Research Shandong University (Shandong Provincial Key New Think Tank)  Jinan China"},{"name":"China National Health Development Research Center  Beijing 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