Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

Aznar-Gimeno, Rocío; Carrera‐Lasfuentes, Patricia; del-Hoyo-Alonso, Rafael; Doblaré, M.; Lanas, Ángel

doi:10.3389/fmed.2021.712040

Cited by 6 publications

(5 citation statements)

References 19 publications

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“… 80 Efforts to mitigate this survival decline are needed, mainly focusing on catching-up CRC screening programs and resuming at least the previous colonoscopy workload in the endoscopic units to meet the demands of screening and diagnostic colonoscopies backlog. Using surrogate biomarkers such as FIT, as well as stratification by other risk factors, 32 , 40 may be useful strategies to prioritize patients with higher risk while resuming the normal endoscopic activity, to minimize this forthcoming increase in CRC mortality by detecting the cases with a higher risk.…”

Section: Discussionmentioning

confidence: 99%

“… 31 However, increasing the colonoscopy capacity is not possible for every health system, so it has been suggested that increasing FIT cutoff or using specific risk factors (male sex and advanced age) could be an effective strategy to prioritize access to colonoscopies and reduced the number of CRC or advanced adenomas underdiagnosed in a CRC screening program, compared with randomly reducing the number of population screened. 32 Colon capsule endoscopy has also been advocated as an alternative for CRC screening after a positive FIT, as it can be performed as an out-of-clinic procedure, avoiding patients to attend medical facilities, and it has demonstrated a high diagnostic accuracy (area under receiver operating curve 0.963 for polyps at least 6 mm); hence, it may be used to filter patients in need of a colonoscopy. 33 In fact, current CRC screening guidelines recommend this technique as a valid alternative for individuals unable or unwilling to undergo colonoscopy.…”

Section: Impact Of Covid-19 Pandemic In Crc Screeningmentioning

confidence: 99%

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The impact of COVID-19 pandemic in the diagnosis and management of colorectal cancer patients

Domper-Arnal

Mallada

Lanas

2022

Therap Adv Gastroenterol

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The novel coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented challenge to healthcare systems worldwide, causing downscaling of almost all other activities, especially in its early stages. Currently, the availability of vaccines along with the spread of new viral variants has modified the epidemiology of the disease, and the previous activity is being gradually resumed in most healthcare facilities. In this review, we have summarized the influence of the COVID-19 pandemic in the diagnosis and management of colorectal cancer (CRC) patients. Population-based screening with either colonoscopy or fecal occult blood tests has proven to reduce CRC incidence and mortality, so screening programs have been implemented in most western countries. However, during the first COVID-19 wave, most of these programs had to be disrupted temporarily. In this review, we have thoroughly analyzed the consequences of these disruptions of screening programs as well as of the forced delays in diagnostic and therapeutic services on CRC prognosis, although its exact impact cannot be exactly measured yet. In any way, strategies to minimize its effect, such as catch-up strategies expanding the colonoscopy capacity or using fecal occult blood concentration and other risk factors to prioritize patients, are urgently needed. The COVID-19 pandemic has also led to a change in CRC patient presentation, with an overall temporary decreased incidence due to postponed diagnoses, but with more patients presenting in need of an emergency admission or with symptoms. Finally, changes in treatment approaches in CRC patients have been reported during the pandemic, namely a drop in the proportion of laparoscopic surgeries or a rise in short-term radiotherapy courses. We have therefore aimed to summarize the available evidence to guide the healthcare professionals treating CRC patients to choose the best treatment options in the current pandemic situation.

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Section: Discussionmentioning

confidence: 99%

Section: Impact Of Covid-19 Pandemic In Crc Screeningmentioning

confidence: 99%

The impact of COVID-19 pandemic in the diagnosis and management of colorectal cancer patients

Domper-Arnal

Mallada

Lanas

2022

Therap Adv Gastroenterol

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“…-f-Hb <120 μg/g: repeat FIT in 3 years; [36,37], -f-Hb 120-180 μg/g: repeat FIT in 6 months. Colonoscopy only if repeated FIT result ≥180 μg/g; [38] and -f-Hb ≥180 μg/g: colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Impact of changes to the interscreening interval and faecal immunochemical test threshold in the national bowel cancer screening programme in England: results from the FIT pilot study

Seedher

Sharples

et al. 2022

Br J Cancer

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Introduction The NHS Bowel Cancer Screening Programme (BCSP) faces endoscopy capacity challenges from the COVID-19 pandemic and plans to lower the screening starting age. This may necessitate modifying the interscreening interval or threshold. Methods We analysed data from the English Faecal Immunochemical Testing (FIT) pilot, comprising 27,238 individuals aged 59–75, screened for colorectal cancer (CRC) using FIT. We estimated screening sensitivity to CRC, adenomas, advanced adenomas (AA) and mean sojourn time of each pathology by faecal haemoglobin (f-Hb) thresholds, then predicted the detection of these abnormalities by interscreening interval and f-Hb threshold. Results Current 2-yearly screening with a f-Hb threshold of 120 μg/g was estimated to generate 16,092 colonoscopies, prevent 186 CRCs, detect 1142 CRCs, 7086 adenomas and 4259 AAs per 100,000 screened over 15 years. A higher threshold at 180 μg/g would reduce required colonoscopies to 11,500, prevent 131 CRCs, detect 1077 CRCs, 4961 adenomas and 3184 AAs. A longer interscreening interval of 3 years would reduce required colonoscopies to 10,283, prevent 126 and detect 909 CRCs, 4796 adenomas and 2986 AAs. Conclusion Increasing the f-Hb threshold was estimated to be more efficient than increasing the interscreening interval regarding overall colonoscopies per screen-benefited cancer. Increasing the interval was more efficient regarding colonoscopies per cancer prevented.

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“…In the discussion of a pandemic‐resilient CRCS, our results may suggest new fundamental elements. Currently examined solutions are mainly regarding: (1) enhancing the participation rate (mailed FIT program 37 and shift toward a more FIT‐focused CRCS 38 ); and (2) improving efficiency for an increased yield (readjustment of the cutoff value of FIT and risk‐stratified colonoscopy based on FIT result 39 ). However, solutions for avoiding a shutdown of cancer screening are not explicitly discussed.…”

Section: Discussionmentioning

confidence: 99%

Pandemic‐resilient target setting in colorectal cancer screening for vulnerable older population

et al. 2022

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Background Colorectal cancer screening (CRCS) needs to be pandemic‐resilient to avoid long‐lasting shutdowns; however, realistic participation target remains unelucidated. This study aimed to identify the lowest acceptable participation rate in CRCS during a pandemic, focusing on vulnerable older populations who require urgent intervention. Methods This nationwide cross‐sectional study included 80,946 inpatients aged 70–85 years who were first diagnosed with colorectal cancer (CRC) after 70 years of age, between April 1, 2014 and March 31, 2019, in Japan. To evaluate the association between area‐level CRCS participation rate and individual early CRC detection, a multilevel logistic regression model was constructed. The mandatorily implemented screening rates were converted to the total screening rate equivalents (TSREs), which reflect the remaining contributions of voluntarily provided screenings. Results Early detections during stages 0–I were significantly observed when primary screening rate was ≥38% (TSRE) and combined follow‐up rate was ≥85%. For early detection during Tis–T1, primary screening rate ≥ 38% (TSRE) and combined follow‐up rate ≥ 90% were necessary. For follow‐up rates ≥70% or ≥75%, there were cases where missed detection of Tis–T1 were observed. Conclusion The results indicate that, even during pandemic, CRCS should achieve a primary screening rate of 38% and follow‐up rate of 85% for vulnerable older populations. These values, lower than the current desirable rates, suggest the maximum possible compromise in balancing the resources between cancer screening and pandemic measures. Moreover, they also indicate the minimum target for shifting to fecal immunochemical test‐focused program. Further explorations with varied CRCS settings are necessary for verification.

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Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

Cited by 6 publications

References 19 publications

The impact of COVID-19 pandemic in the diagnosis and management of colorectal cancer patients

The impact of COVID-19 pandemic in the diagnosis and management of colorectal cancer patients

Impact of changes to the interscreening interval and faecal immunochemical test threshold in the national bowel cancer screening programme in England: results from the FIT pilot study

Pandemic‐resilient target setting in colorectal cancer screening for vulnerable older population

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