Abstract
<title>Abstract</title> <p>Background Community-based colorectal cancer screening requires a screening-to-care pathway that links initial risk assessment with diagnostic colonoscopy, endoscopic quality control, pathology, treatment completion, and follow-up. We evaluated this pathway under an integrated medical consortium model in Southern Jiangsu, China. Methods Screening records from Bingxi, Penglang, Zhenchuan, and Qingyang communities during 2023–2025 were standardized across heterogeneous routine forms, distinguishing registered screening episodes from unique screened individuals. Initial screening variables included demographics, CNP score or HRFQ-based risk assessment, and gFOBT results; colonoscopy records included examination completion, cecal intubation, bowel preparation, pathology, and treatment follow-up. gFOBT positivity and CNP/HRFQ high-risk rates were calculated among records with definite results or completed assessments. Colonoscopy compliance used high-risk or gFOBT-positive status as the indication for colonoscopy, with proportional estimation for partially missing initial indicators. Advanced adenoma was defined as size greater than 1 cm, villous or serrated pathology, or high-grade intraepithelial neoplasia; high-risk neoplasia included high-grade intraepithelial neoplasia and colorectal cancer. Results A total of 10,641 initial records were registered, and 9,516 unique screened individuals were included after identity verification. Among 9,491 individuals with determinable sex, 6,046 were women and 3,445 were men; mean age was 62.1 years. Definite gFOBT results were available for 7,488 records, with 467 positives (6.2%). CNP/HRFQ assessment was completed in 9,633 records, with 2,624 high-risk or positive results (27.2%). The estimated colonoscopy-eligible denominator was 3,311.0, and 925 colonoscopies were completed (27.9%). Among completed colonoscopies, cecal intubation reached 93.0%, adequate bowel preparation 85.5%, adenoma detection 46.4%, advanced adenoma 18.3%, and high-risk neoplasia 4.2%. Among 173 patients requiring timely treatment, 154 completed treatment (89.0%). Conclusions The program identified high-risk residents and achieved high diagnostic yield among participants who completed colonoscopy. The major weakness was the transition from positive or high-risk initial screening to diagnostic colonoscopy, whereas treatment completion was strong after entry into the clinical pathway. These findings support evaluating community screening as a service cascade and prioritizing colonoscopy completion as the main improvement target. Trial registration Not applicable.</p>