Changes in FIT values below the threshold of positivity and short-term risk of advanced colorectal neoplasia: Results from a population-based cancer screening program

Burón, Andrea; Román, Marta; Augé, Josep M.; Macià, Francesc; Grau, Jaume; Sala, María; Louro, Javier; Martínez-Alonso, Montserrat; Álvarez–Urturi, Cristina; Andreu, Montserrat; Bessa, Xavier; Zaffalon, Diana; Castells, Antoni; Pellisé, María; Aldea, Marta; Rivero, Liseth; Hernández, Cristina; Torà-Rocamora, Isabel; Castells, Xavier

doi:10.1016/j.ejca.2018.11.004

Cited by 21 publications

(27 citation statements)

References 14 publications

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“…Data about IC incidence were available only for a subgroup of screenees and the information was updated only up to 2012, which did not allow to quantify the CRC risk over several rounds. Our results are however confirming the findings of previous studies9 showing a similar positive association of cumulative f-Hb with the risk of SD AN and of IC. Also, the IC rate observed in this subgroup is consistent with the estimates form previous reports in the areas covered by the study19 20…”

Section: Discussionsupporting

confidence: 93%

“…Their risk was still twice as high as compared with the subjects with a cumulative f-Hb in the range 15–19.9 µg/g. The cumulative AN risk was similar in the younger (50–59) as in the older (60–69) age group, while it was higher among men, as compared with women, as already reported in a previous analyses 8 9…”

Section: Discussionsupporting

confidence: 85%

“…Within-subject correlation between consecutive f-Hb levels was weak, although statistically significant, and, as already reported,8 9 the predictive value of cumulative f-Hb was similar, independent of the sequence of the f-Hb results.…”

Section: Discussionsupporting

confidence: 81%

“…The Dutch study8 reported, over a 8-year follow-up, a similar trend in the overall AN risk, including both SD and ICs, by cumulative f-Hb after two consecutive negative FITs as in our study, but it did not provide specific information by screening round, or about the size of the risk subgroups, which might be useful to orient screening policies. A recent Spanish study,9 using the same cut-off as in our programmes, reported a similar 22-fold increase in the risk of being detected with an AN at the third round among subjects with two consecutive high (10–19.9 µg Hb/g faeces) negative FITs. However, the choice to classify subjects based on nine possible combinations of three broad groups of f-Hb concentration may not adequately account for the available quantitative information and it may not be easily translated into practice, as there are three combinations showing a similar risk.…”

Section: Discussionsupporting

confidence: 74%

“…The predictive role of f-Hb concentration among subjects with FIT results below the positivity cut-off has been assessed in three recent studies, conducted in the context of mass screening programmes. The f-Hb concentration, at first screening,7 or over two consecutive negative FITs8 9, emerged as an independent predictor of the subsequent risk of AN, both screen detected (SD) and not SD, although only one study9 could provide information about the association of f-Hb concentrations of consecutive tests with the screening outcomes at the subsequent round.…”

Section: Introductionmentioning

confidence: 98%

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Faecal haemoglobin concentration among subjects with negative FIT results is associated with the detection rate of neoplasia at subsequent rounds: a prospective study in the context of population based screening programmes in Italy

Senore

Zappa²,

Campari

et al. 2019

Gut

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ObjectiveTo estimate the predictive role of faecal haemoglobin (f-Hb) concentration among subjects with faecal immunochemical test (FIT) results below the positivity cut-off for the subsequent risk of advanced neoplasia (AN: colorectal cancer—CRC—or advanced adenoma).DesignProspective cohort of subjects aged 50–69 years, undergoing their first FIT between 1 January 2004 and 31 December 2010 in four population-based programmes in Italy.MethodsAll programmes adopted the same analytical procedure (OC Sensor, Eiken Japan), performed every 2 years, on a single sample, with the same positivity cut-off (20 µg Hb/g faeces). We assessed the AN risk at subsequent exams, the cumulative AN detection rate (DR) over the 4-year period following the second FIT and the interval CRC (IC) risk following two negative FITs by cumulative amount of f-Hb concentration over two consecutive negative FITs, using multivariable logistic regression models and the Kaplan-Meier method.ResultsThe cumulative probability of a positive FIT result over the subsequent two rounds ranged between 7.8% (95% CI 7.5 to 8.2) for subjects with undetectable f-Hb at the initial two tests (50% of the screenees) and 48.4% (95% CI 44.0 to 53.0) among those (0.7% of the screenees) with a cumulative f-Hb concentration ≥20 µg/g faeces. The corresponding figures for cumulative DR were: 1.4% (95% CI 1.3 to 1.6) and 25.5% (95% CI 21.4 to 30.2) for AN; 0.17% (95% CI 0.12 to 0.23) and 4.5% (95% CI 2.8 to 7.1) for CRC. IC risk was also associated with cumulative f-Hb levels.ConclusionThe association of cumulative f-Hb concentration with subsequent AN and IC risk may allow to design tailored strategies to optimise the utilisation of endoscopy resources: subjects with cumulative f-Hb concentration ≥20 µg/g faeces over two negative tests could be referred immediately for total colonoscopy (TC), while screening interval might be extended for those with undetectable f-Hb.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 98%

See 3 more Smart Citations

Faecal haemoglobin concentration among subjects with negative FIT results is associated with the detection rate of neoplasia at subsequent rounds: a prospective study in the context of population based screening programmes in Italy

Senore

Zappa²,

Campari

et al. 2019

Gut

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A single measurement of fecal hemoglobin concentration outperforms polygenic risk score in colorectal cancer risk assessment

Niedermaier

Alwers

Chen

et al. 2023

Cancer Communications

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The second round of the Dutch colorectal cancer screening program: Impact of an increased fecal immunochemical test cut‐off level on yield of screening

Kooyker

Toes‐Zoutendijk

Winden

et al. 2020

Intl Journal of Cancer

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The Dutch colorectal cancer (CRC) screening program started in 2014, inviting the target population biennially to perform a fecal immunochemical test (FIT). We obtained prospectively collected data from the national screening information‐system to present the results of the second round (2016) and evaluate the impact of increasing the FIT cut‐off halfway through the first round from 15 to 47 μg Hb/g feces on outcomes in the second round. Second round screening was done with a 47 μg Hb/g feces FIT cut‐off. Participants were classified based on first round participation status as either FIT (15,47) or FIT (47,47) participants, and previous nonparticipants. In total, 348,891 (75.9%) out of 459,740 invitees participated in the second round. Participation rates were 93.4% among previous participants and 21.0% among previous non‐participants. FIT(47,47) participants had a significantly higher detection rate of AN (15.3 vs. 10.4 per 1,000 participants) compared to FIT(15,47) participants in the second round, while their cumulative detection rate of AN over two rounds was significantly lower (45.6 vs. 52.6 per 1,000 participants). Our results showed that participation in the Dutch CRC screening program was consistently high and that second round detection rates depended on the first round FIT cut‐off. The cumulative detection over two rounds was higher among FIT(15,47) participants. These findings suggest that a substantial part of, but not all the missed findings in the first round due to the increased FIT cut‐off were detected in the subsequent round.

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Changes in FIT values below the threshold of positivity and short-term risk of advanced colorectal neoplasia: Results from a population-based cancer screening program

Cited by 21 publications

References 14 publications

Faecal haemoglobin concentration among subjects with negative FIT results is associated with the detection rate of neoplasia at subsequent rounds: a prospective study in the context of population based screening programmes in Italy

Faecal haemoglobin concentration among subjects with negative FIT results is associated with the detection rate of neoplasia at subsequent rounds: a prospective study in the context of population based screening programmes in Italy

A single measurement of fecal hemoglobin concentration outperforms polygenic risk score in colorectal cancer risk assessment

The second round of the Dutch colorectal cancer screening program: Impact of an increased fecal immunochemical test cut‐off level on yield of screening

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