Diagnostic accuracy of fecal immunochemical test in average‐ and familial‐risk colorectal cancer screening

Cubiella, Joaquín; Castro, Inês; Hernández, Vicent; González-Mao, Carmen; Rivera, Concepción; Iglesias, Felipe; Alves, Maria Teresa de Seixas; Cid, Lucía; Soto, Santiago; de–Castro, Luisa; Vega, Pablo; Hermo, José Antonio; Macenlle, Ramiro; Martínez, Alfonso; Estévez, Pamela; Cid, Estela; Herreros-Villanueva, Marta; Portillo, Isabel; Bujanda, Luís; Fernández-Seara, Javier

doi:10.1177/2050640614553285

Cited by 21 publications

(20 citation statements)

References 35 publications

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“…Additionally this information could explain one of the most striking ndings of our study. Although males have an increased risk of advanced neoplasia detection in CRC screening [28] and account for 75% of the high risk lesions detected, [29] in our study, females have an increased risk of surgery. The reason is unclear and we suggest it may be related to differences in the natural history of CRC.…”

Section: Discussionmentioning

confidence: 53%

Overtreatment in Nonmalignant Lesions Detected in a Colorectal Cancer Screening Program: A Cross-Sectional Analysis.

Cubiella

González

Almazán

et al. 2020

Preprint

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Background: Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study is to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods: We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI).Results: We included 15,707 patients in the analysis with high (19.3%), intermediate (25.1%) low risk (21.7%) adenomas and normal colonoscopy (27.8%) detected in the analyzed period. Colorectal surgery was performed in 162 (10.3‰, 95% CI 8.7-11.9), due to colonoscopy complications (0.2‰, 95% CI 0.005-0.5) and resection of colorectal benign lesions (10.0‰, 95% CI 8.5-11.6). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications, one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years= 1.57, 95% CI 1.11-2.23), sex (female= 2.10, 95% CI 1.52-2.91), the European guidelines classification (high risk= 67.94, 95% CI 24.87-185.59; intermediate risk= 5.63, 95% CI 1.89-16.80; low risk= 1.43; 95% CI 0.36-5.75), the endoscopist’s ADR (Q4= 0.44, 95% CI 0.28-0.68; Q3= 0.44, 95% CI 0.27-0.71; Q2= 0.71, 95% CI 0.44-1.14) and the hospital (third level= 0.54, 95% CI 0.38-0.79). Conclusions: In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are acceptable and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity.

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Section: Discussionmentioning

confidence: 53%

Overtreatment in Nonmalignant Lesions Detected in a Colorectal Cancer Screening Program: A Cross-Sectional Analysis.

Cubiella

González

Almazán

et al. 2020

Preprint

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“…Furthermore, a retrospective study comparing the performance of FIT (OC-Sensor, cut-off 20 mcg Hb/g feces) in average risk patients enrolled in the colonoscopy arm of the COLONPREV trial ( 10 ) and individuals with a FDR with CRC showed similar sensitivities and specificities for the detection of advanced neoplasia between the two patient populations ( 11 ). In addition, there was no difference in FIT performance when comparing the number of FDRs with CRC or their age of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Performance of the Fecal Immunochemical Test in Patients With a Family History of Colorectal Cancer

Moosavi

Gentile²,

Gondara³

et al. 2019

Journal of the Canadian Association of Gastroenterology

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Objective To assess the performance of a fecal immunochemical test (FIT) among participants of a population-based colorectal cancer (CRC) screening program with one or more first-degree relatives (FDR) with CRC. Methods Asymptomatic 50 to 74 years olds with a FDR diagnosed with CRC, enrolled in a colon screening program completed FIT (two samples, cut-off 20 µg Hemoglobin/gram feces) and underwent colonoscopy. FIT-interval CRCs were identified from the British Columbia cancer registry. Logistic regression analysis was used to identify variables associated with the detection of CRC and high-risk polyps (nonmalignant findings that required a 3-year surveillance colonoscopy) in those patients undergoing FIT and colonoscopy. Results Of the 1387 participants with a FDR with CRC, 1244 completed FIT with a positivity rate of 10.8%, 52 declined FIT but underwent colonoscopy and 90 declined screening. Seven CRCs were identified: six in patients with a positive FIT, one in a patient who only had colonoscopy. No CRCs were found in patients with a negative FIT. The positive and negative predictive values of FIT in the detection of CRC were 4.8% and 100%, respectively. On multivariate logistic regression, positive FIT, and not type of family history, was the only variable associated with detection of CRC or high-risk polyps. At 2-year follow-up, there was no FIT interval cancer detected in the study cohort. Conclusion FIT is more strongly associated with high-risk findings on colonoscopy than type of family history. FIT may be an alternative screening strategy to colonoscopy in individuals with a single FDR with CRC.

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“…In fact, the same screening strategy as that for average-risk individuals could be recommended to men and women having only one FDR with colorectal cancer, but starting at the age of 40 or 45 y, in line with the results of previous studies [ 5 , 30 ], thus avoiding overuse of screening colonoscopy. In support of this recommendation, there are two recent prospective studies demonstrating that fecal immunochemical testing is as effective as colonoscopy to detect advanced neoplasia in colorectal cancer associated with familial risk [ 19 , 41 ]. In contrast, the higher prevalence and earlier presentation of advanced neoplasia in men having two FDR with colorectal cancer suggest that men have higher genetic penetrance, thus supporting screening colonoscopy from the age of 40, whereas it could be delayed until the age of 50 or older in women with two FDR.…”

Section: Discussionmentioning

confidence: 99%

Risk of Advanced Neoplasia in First-Degree Relatives with Colorectal Cancer: A Large Multicenter Cross-Sectional Study

et al. 2016

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BackgroundFirst-degree relatives (FDR) of patients with colorectal cancer have a higher risk of developing colorectal cancer than the general population. For this reason, screening guidelines recommend colonoscopy every 5 or 10 y, starting at the age of 40, depending on whether colorectal cancer in the index-case is diagnosed at <60 or ≥60 y, respectively. However, studies on the risk of neoplastic lesions are inconclusive. The aim of this study was to determine the risk of advanced neoplasia (three or more non-advanced adenomas, advanced adenoma, or invasive cancer) in FDR of patients with colorectal cancer compared to average-risk individuals (i.e., asymptomatic adults 50 to 69 y of age with no family history of colorectal cancer).Methods and FindingsThis cross-sectional analysis includes data from 8,498 individuals undergoing their first lifetime screening colonoscopy between 2006 and 2012 at six Spanish tertiary hospitals. Of these individuals, 3,015 were defined as asymptomatic FDR of patients with colorectal cancer (“familial-risk group”) and 3,038 as asymptomatic with average-risk for colorectal cancer (“average-risk group”). The familial-risk group was stratified as one FDR, with one family member diagnosed with colorectal cancer at ≥60 y (n = 1,884) or at <60 y (n = 831), and as two FDR, with two family members diagnosed with colorectal cancer at any age (n = 300). Multiple logistic regression analysis was used for between-group comparisons after adjusting for potential confounders (age, gender, and center). Compared with the average-risk group, advanced neoplasia was significantly more prevalent in individuals having two FDR with colorectal cancer (odds ratio [OR] 1.90; 95% confidence interval [CI] 1.36–2.66, p < 0.001), but not in those having one FDR with colorectal cancer diagnosed at ≥60 y (OR 1.03; 95% CI 0.83–1.27, p = 0.77) and <60 y (OR 1.19; 95% CI 0.90–1.58, p = 0.20). After the age of 50 y, men developed advanced neoplasia over two times more frequently than women and advanced neoplasia appeared at least ten y earlier. Fewer colonoscopies by 2-fold were required to detect one advanced neoplasia in men than in women.Major limitations of this study were first that although average-risk individuals were consecutively included in a randomized control trial, this was not the case for all individuals in the familial-risk cohort; and second, the difference in age between the average-risk and familial-risk cohorts.ConclusionsIndividuals having two FDR with colorectal cancer showed an increased risk of advanced neoplasia compared to those with average-risk for colorectal cancer. Men had over 2-fold higher risk of advanced neoplasia than women, independent of family history. These data suggest that screening colonoscopy guidelines should be revised in the familial-risk population.

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Diagnostic accuracy of fecal immunochemical test in average‐ and familial‐risk colorectal cancer screening

Cited by 21 publications

References 35 publications

Overtreatment in Nonmalignant Lesions Detected in a Colorectal Cancer Screening Program: A Cross-Sectional Analysis.

Overtreatment in Nonmalignant Lesions Detected in a Colorectal Cancer Screening Program: A Cross-Sectional Analysis.

Performance of the Fecal Immunochemical Test in Patients With a Family History of Colorectal Cancer

Risk of Advanced Neoplasia in First-Degree Relatives with Colorectal Cancer: A Large Multicenter Cross-Sectional Study

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