A higher detection rate for colorectal cancer and advanced adenomatous polyp for screening with immunochemical fecal occult blood test than guaiac fecal occult blood test, despite lower compliance rate. A prospective, controlled, feasibility study

Abstract

Immunochemical fecal occult blood test (FIT) is a new colorectal cancer (CRC) screening method already recommended by the American screening guidelines. We aimed to test the feasibility of FIT as compared to guaiac fecal occult blood test (G-FOBT) in a large urban population of Tel Aviv. Average-risk persons, aged 50-75 years, were offered FIT or G-FOBT after randomization according to the socioeconomic status of their clinics. Participants with positive tests underwent colonoscopy. Participants were followed through the Cancer Registry 2 years after the study. Hemoccult SENSA TM and OC-MICRO TM (three samples, 70 ng/ml threshold) were used. FIT was offered to 4,657 persons (Group A) and G-FOBT to 7,880 persons (Group B). Participation rate was 25.9% and 28.8% in Group A and B, respectively (p < 0.001). Positivity rate in Group A and B was 12.7% and 3.9%, respectively (p < 0.001). Cancer found in six (0.49%) and eight (0.35%) patients of Group A and B, respectively (NS). Cancer registry follow-up found missed cancer in five (0.22%) cases of Group B and none in Group A (NS). The sensitivity, specificity, negative and positive predictive value for cancer in Group A and B were 100%, 85.9%, 100%, 3.9% and 61.5%, 96.4%, 99.8%, 9.1%, respectively. There was increased detection of advanced adenomatous polyp (AAP) by FIT, irrespective of age, gender, and socioeconomic status (Per Protocol: odds ratio 2.69, 95% confidence interval 1.6-4.5; Intention to Screen: odds ratio 3.16, 95% confidence interval 1.8-5.4). FIT is feasible in urban, average-risk population, which significantly improved performance for detection of AAP and CRC, despite reduced participation.

Colonoscopy quality assessment in a mass population screening programme based on faecal occult blood test

“…Consistent with previous results (33)(34)(35), FIT obtained much better detection rates than the gFOBT. Our results should be interpreted carefully when compared with other screening programmes.…”

Meta‐analysis: adherence to colorectal cancer screening and the detection rate for advanced neoplasia, according to the type of screening test

“…27,33 Only one study asked for consent before randomisation. 25 Four studies reported using a cluster randomisation, 26,28,33,35 but only two accounted for it in the analysis. 26,28 Although 6 studies adopted algorithms in the randomisation that forced people from the same household or at the same address to be allocated to the same arm, 23,24,27,30,33,36 none of them accounted for it in the analysis (the effect on variance of this clustering is usually irrelevant, as usually only one subject per household and rarely two are eligible).…”

“…Inter-study heterogeneity (I 2 ) was 96%. Such heterogeneity appeared to be related only to one series, 35 its exclusion resulting in a I 2 equal to 0%. The detection rate for advanced neoplasia and cancer with FIT was also superior to g-FOBT at both PP Figure 2 | g-FOBT vs.…”

Factors affecting compliance in faecal occult blood testing: a cluster randomized study of the faecal immunochemical test versus the guaiac faecal occult test

“…In our recent paper we reported that FIT was feasible and that its usage was associated with an improved performance for the detection of advanced adenomatous polyps (AAP) and CRC. 6 We here compare test uptake in the FIT arm with that in the gFOBT arm, with special emphasis on demographic and socioeconomic factors that might affect compliance.…”