The optimal cut‐off value in fit‐based colorectal cancer screening: An observational study

Abstract

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Using fecal immunochemical test values below conventional cut-off to individualize colorectal cancer screening

“…Unexpectedly, we found no statistically significant difference in CRC incidence between men and women. Numerous studies have suggested that the FIT is more sensitive in men than in women, as women more often have right-sided cancer, which tends to bleed less 16 17 18 . Therefore, we would have expected the number of cancers in the FIT-negative group to be higher in women than in men.…”

Varying fecal immunochemical test screening cutoffs by age and gender: a way to increase detection rates and reduce the number of colonoscopies

“…In a previous article we showed that the ratio between the number of true-positive cases and the number of falsenegative cases was approximately 2.8 for cutoff values close to 100 ng Hb/mL. 7 This ratio is probably larger below 100 ng Hb/mL and smaller above 100 ng Hb/mL, whereas we assumed that the ratio decreases linearly going through 2.8 at 100 ng Hb/mL and 1.0 at 1000 ng Hb/mL (Fig. 1, solid line).…”

“…Choosing the optimal cutoff value is a delicate decision requiring consideration of both benefits and harms. 7 Although it has been shown that sensitivity and specificity of the FIT varies by age and gender [8][9][10][11][12] and studies have emphasized the need for more tailored screening strategies, 8 most population-based CRC screening programs have chosen to use the same cutoff value for all participants. The aim of this study was to develop age-and gender-specific cutoff values using data from the prevalent round of the Danish FIT-based CRC screening program and to test their performance in silico.…”

Colon Capsule Endoscopy in the Diagnosis of Colon Polyps: Who Needs a Colonoscopy?

“…A positive test triggers a recommendation for conventional colonoscopy. False positive FIT tests relate to stool concentration, with sensitivity increasing and specificity decreasing with higher cut-off levels [ 77 ]. The test cannot distinguish bleeding arising from advanced neoplasia or from non-neoplastic disorders, including peptic ulceration, inflammatory bowel, and hematological diseases [ 78 ].…”

“…In attempts to determine optimal cut-off points for triggering a colonoscopy, proposals have ranged from 45–150 ng Hb/mL. However, there remain a small subgroup of patients with levels of 10–45 ng/mL where advanced neoplasia will be missed, and for this reason, NHS England has proposed a clinical evaluation, offering CCE to individuals with FIT concentrations in the 10–99 ng Hb/mL range [ 76 , 77 , 78 ].…”