Piloting gender-oriented colorectal cancer screening with a faecal immunochemical test: population-based registry study from Finland

Sarkeala, Tytti; Färkkilä, Martti; Anttila, Ahti; Hyöty, Marja; Kairaluoma, Matti I.; Rautio, Tero; Voutilainen, Markku; Helander, Sanni; Jäntti, Maija; Lehtinen, Milla; Patrikka, Lotta; Malila, Nea; Heinävaara, Sirpa

doi:10.1136/bmjopen-2020-046667

Cited by 27 publications

(22 citation statements)

References 21 publications

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“… 2 In addition, a recent study from Finland showed that using > 25 μg Hb/g faeces for women and > 70 μg Hg/g faeces for men gave similar CRC detection rates in both genders (0.16% for women and 0.18% for men) and similar PPV for CRC (6.4% for women and 6.6% for men). 25 However, in this Finnish study, the positivities in women and men using these thresholds were 2.6% and 2.4%, respectively. These positivities are considerably lower than those currently observed at similar thresholds in Scotland, perhaps due to demographic factors such as lifestyle, and also because f-Hb concentrations found are highly dependent on the FIT system employed, 26 so the results from Finland are not necessarily transferable over geography.…”

Section: Discussioncontrasting

confidence: 53%

“… 11 , 12 Thus, the issue of whether or not partitioned f-Hb thresholds should be used for women and men can only be resolved by prospective, observational studies. The distributions of f-Hb concentrations in men and women with CRC, the newer data from Scandinavia, 25 , 28 and other evidence on screening outcomes, as detailed above, indicate that lowering the f-Hb concentration threshold in women would increase the chances of detecting CRC in those participating in screening. However, there are areas of significant uncertainty and these include the extent to which CRC detection rates in women and men would converge, the effect on the PPV and the consequent harms of any increase in the false positive rate, the effect on interval cancer rates in women and the cost-effectiveness of this strategy.…”

Section: Discussionmentioning

confidence: 92%

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Faecal haemoglobin concentrations in women and men diagnosed with colorectal cancer in a national screening programme

et al. 2021

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Objective There is evidence that colorectal cancer screening using faecal haemoglobin is less effective in women than men. The faecal haemoglobin concentrations were therefore examined in women and men with screen-detected colorectal cancer. Setting Scottish Bowel Screening Programme, following the introduction of a faecal immunochemical test from November 2017, to March 2020. Methods Data were collated on faecal haemoglobin concentrations, pathological stage and anatomical site of the main lesion in participants who had colorectal cancer detected. The data in women and men were compared. Results For the faecal haemoglobin concentrations studied (>80 µg Hb/g faeces), the distributions indicated lower concentrations in women. Marked differences were found between women and men diagnosed with colorectal cancer. The median faecal haemoglobin concentration for women ( n = 720) was 408 µg Hb/g faeces compared to 473 µg Hb/g faeces for men ( n = 959) ( p = 0.004) and 50.6% of the results were >400 µg Hb/g faeces in women; in men, this was 57.8%. The difference in faecal haemoglobin concentrations in women and men became less statistically significant as stage advanced from stages I–IV. For right-sided, left-sided and rectal colorectal cancer, a similar gender difference persisted in all sites. Differences in faecal haemoglobin between the genders were significant for left-sided cancers and stage I and approached significance for rectal cancers and stage II, but all sites and stages showed lower median faecal haemoglobin concentrations for women. Conclusions To minimise gender inequalities, faecal immunochemical test-based colorectal cancer screening programmes should evaluate a strategy of using different faecal haemoglobin concentration thresholds in women and men.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 92%

Faecal haemoglobin concentrations in women and men diagnosed with colorectal cancer in a national screening programme

et al. 2021

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Background and study aims Of the participants in the Danish screening program, 89.9 % to 92.5 % have fecal immunochemical test (FIT) values < 10 μg/g feces (equivalent to 50 ng hemoglobin/mL buffer). This study aimed to investigate the risk of interval colorectal cancer (CRC) in this group before the next biennial screening round. Patients and methods This cohort study included all citizens from the region of Southern Denmark who participated in the Danish bowel screening program from 2014 trough 2016 and had a FIT value < 10 μg/g feces. Individuals receiving a CRC diagnosis were identified through the national CRC registry, with a follow up of 2 years corresponding to the current screening interval. We also examined the 3-year CRC incidence. Hazard ratios (HRs) were estimated using univariate and multivariate Cox proportional hazard regression models. Results Data from 185,654 citizens presenting with a FIT value < 10 μg/g feces were eligible for analysis. Overall, interval CRC incidence was 0.07 % within 2 years with HRs of 4.16 (95 % confidence interval [CI] 2.67;6.48) and 5.8 (95 % CI 3.34;10.05) for FIT values of 4 to 6.9 μg/g feces and 7 to 9.9 μg/g feces, respectively, compared to those having a FIT value below the limit of quantification of 4 μg/g feces. After 3 years, the overall CRC incidence increased to 0.14 %; however, this was not significant. Conclusions This study demonstrates a positive correlation between FIT value and risk of interval cancer even for very low values. It further suggests that an increase in the screening interval could be reasonable in the low FIT categories.

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“…How to further stratify the target screening population becomes an important issue. Using age- and gender-specific FIT cutoffs or applying a risk scoring system that accommodates common risk factors may become feasible solutions ( Chen et al, 2018 ; Sarkeala et al, 2021 ; Chiu et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Mitigating the impact of COVID-19 on colorectal cancer screening: Organized service screening perspectives from the Asia-Pacific region

Chiu

Hsu

et al. 2021

Preventive Medicine

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Colorectal cancer(CRC) is one of the most prevalent malignancies in the Asia-Pacific region, and many countries in this region have launched population CRC service screening. In this study, CRC screening key indicators, including the FIT(fecal immunochemical test) screening rate (or participation rate) and the rate of undergoing colonoscopy after positive FIT in 2019 and 2020, were surveyed in individual countries in the Asia-Pacific region. The impact of the pandemic on the effectiveness of CRC screening was simulated given different screening rates and colonoscopy rates and assuming the pandemic would persist or remain poorly controlled for a long period of time, using the empirical data from the Taiwanese program and the CRC natural history model. During the COVID-19 pandemic, most of the programs in this region were affected, but to different extents, which was largely influenced by the severity of the local pandemic. Most of the programs continued screening services in 2020, although a temporary pause occurred in some countries. The modeling study revealed that prolonged pauses of screening led to 6% lower effectiveness in reducing CRC mortality. Screening organizers should coordinate with health authorities to elaborate on addressing screening backlogs, setting priorities for screening, and applying modern technologies to overcome potential obstacles. Many novel approaches that were developed and applied during the COVID-19 pandemic, such as the risk-stratified approach that takes into account personal CRC risk and the local epidemic status, as well as new digital technologies, are expected to play important roles in CRC screening in the future.

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Piloting gender-oriented colorectal cancer screening with a faecal immunochemical test: population-based registry study from Finland

Cited by 27 publications

References 21 publications

Faecal haemoglobin concentrations in women and men diagnosed with colorectal cancer in a national screening programme

Faecal haemoglobin concentrations in women and men diagnosed with colorectal cancer in a national screening programme

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

Mitigating the impact of COVID-19 on colorectal cancer screening: Organized service screening perspectives from the Asia-Pacific region

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