Impact of a higher fecal immunochemistry test cut-off on pathology detected in subsequent rounds of a colorectal screening program

Gibson, David J.; Mooney, Therese; Mooney, Jennifer; Mulcahy, Hugh; O’Donoghue, Diarmuid

doi:10.1016/j.gie.2018.08.015

Cited by 7 publications

(7 citation statements)

References 15 publications

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“…These results agree with previous data already described in the literature. Furthermore, the increased risk of detecting a neoplasia during a new screening 2 years after a negative screening test result has already been reported in Ireland[ 14 ] and recently in the Ile-de-France region[ 27 ]. These authors observed variable proportions of pathologies (advanced adenomas or CRC) during a subsequent campaign and hypothesized that these lesions could have been diagnosed during the previous campaign if the FIT positivity threshold was not relatively high.…”

Section: Discussionmentioning

confidence: 99%

“…These authors observed variable proportions of pathologies (advanced adenomas or CRC) during a subsequent campaign and hypothesized that these lesions could have been diagnosed during the previous campaign if the FIT positivity threshold was not relatively high. However, they admitted that lowering the positivity threshold would both allow the diagnosis of lesions that could be serious only 2 years later and create an unsustainable endoscopy referral burden[ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…It was shown that the rate of positive test results with FIT does not decrease during the subsequent campaigns, but the positive predictive value for advanced neoplasia, especially for CRC, significantly decreased in participants during the subsequent campaign after a first negative test[ 12 , 13 ]. A relationship between the fecal hemoglobin concentration (Fhb) and the risk to detect a CRC or an advanced adenoma has also been shown[ 14 - 21 ], but the severity risk of the colorectal lesions according to the earlier Fhb was poorly described.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program

Balamou¹,

Koïvogui²,

Rodrigue³

et al. 2021

WJG

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BACKGROUND The rate of positive tests using fecal immunochemical test (FIT) does not decrease with subsequent campaigns, but the positive predictive value of advanced neoplasia significantly decreases in subsequent campaign after a first negative test. A relationship between the fecal hemoglobin concentration (Fhb) and the opportunity to detect a colorectal cancer in subsequent campaign has been shown. AIM To predict the severity of colorectal lesions based on Fhb measured during previous colorectal cancer screening campaign. METHODS This etiological study included 293750 patients aged 50-74, living in Auvergne-Rhône-Alpes (France). These patients completed at least two FIT [test (-1) and test (0) ] between June 2015 and December 2019. Delay between test (-1) and test (0) was > 1 year and test (-1) result was negative (< 150 ngHb/mL). The severity of colorectal lesions diagnosed at test (0) was described according to Fhb measured at test (-1) [Fhb (-1) ]. The relationship between the severity classified in seven ordinal categories and the predictive factors was analyzed in an ordered multivariate polytomous regression model. RESULTS The test (0) positive rate was 4.0%, and the colonoscopy completion rate was 97.1% in 11594 patients who showed a positive test (0) . The colonoscopy detection rate was 77.7% in those 11254 patients who underwent a colonoscopy. A total of 8748 colorectal lesions were detected (including 2182 low-risk-polyps, 2400 high-risk-polyp, and 502 colorectal cancer). The colonoscopy detection rate varied significantly with Fhb (-1) [0 ngHb/mL: 75.6%, (0-50 ngHb/mL): 77.3%, (50-100 ngHb/mL): 88.7%, (100-150 ngHb/mL): 90.3%; P = 0.001]. People with a Fhb (-1) within (100-150 ngHb/mL) ( P = 0.001) were 2.6 (2.2; 3.0) times more likely to have a high severity level compared to those having a Fhb (-1) value of zero. This risk was reduced by 20% in patients aged 55-59 compared to those aged < 55 [adjusted odds ratio: 0.8 (0.6; 1.0)]. CONCLUSION The study showed that higher Fhb (-1) is correlated to an increased risk of severity of colorectal lesions. This risk of severity increased among first-time participants (age < 55) and the elderly (≥ 70). To avoid the loss of chance in these age groups, the FIT positivity threshold should be reduced to 100 ngHb/mL. The other alternative would be to reduce the time between the two tests in these age groups from the current 2 years to 1 year.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program

Balamou¹,

Koïvogui²,

Rodrigue³

et al. 2021

WJG

View full text Add to dashboard Cite

show abstract

“…Several approaches to optimisation have been taken, most importantly the use of faecal immunochemical tests (FITs) versus the traditional guaiac-based faecal occult blood tests, [14][15][16] but also a two-tier reflex approach, 17 varying screening frequency 18 or the threshold used with FIT, 19,20 personalising the threshold by including factors such as sex and age in a risk-score, [21][22][23][24] or going further, for example through neural network risk modelling. 25 The European Commission's scientific advisors advocate the approach of threshold individualisation as a way to improve CRC screening programmes.…”

Section: Introductionmentioning

confidence: 99%

One or two faecal immunochemical tests in an organised population-based colorectal cancer screening programme in Murcia (Spain)

Tourne-Garcia¹,

Pérez-Riquelme²,

Monteagudo-Piqueras³

et al. 2022

J Med Screen

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Objective Roll-out of population-based colorectal cancer (CRC) screening with faecal immunochemical test (FIT) is limited by availability of further investigations, particularly colonoscopy and examination of excised lesions. Our objective was to assess whether variation in number of faecal samples and threshold adjustment can optimise resource utilisation and CRC detection rate. Methods Three different screening strategies were compared for the same FIT threshold using a quantitative FIT system: one FIT, positive when >20 µg Hb/g faeces; two FIT, positive when either was >20 µg Hb/g faeces; and two FIT, positive when the mean was >20 µg Hb/g faeces. We calculated changes in the size of population the provider could invite to screening for an equal number of screening positive results, and CRC and adenoma detected. Results In our setting, Region of Murcia, south of Spain (not fully rolled out screening programme), changing the usual strategy of two FIT, positive when either to positive when the mean was >20 µg Hb/g faeces, would increase population invited by 37.81% with the same number of positive results (which would generate a CRC detection rate of 19.2%). In a fully rolled out programme, changing the strategy from one to two FIT (positive when the mean is >20 µg Hb/g faeces), would increase CRC detection rate by 4.64% with an increase of only 13.34% in positive FIT. Conclusions In a population-based CRC screening programme, smart use of number of FITs and positivity threshold can increase population invited and CRC detection without increasing the number of colonoscopies and pathological examinations needed.

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“…Similarly, in a survey report of China in 2015, the number of CRC patients and deaths were 376,300 and 191,000 respectively, followed by gastric cancer, liver cancer, and esophageal cancer ( 5 ). CRC patients can have a higher survival rates if having an early diagnosis and fit treatment ( 6 , 7 ). About 8 to 29% of CRC patients were obstructive colorectal cancer (OCRC) when diagnosed at the first time ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Serum Chemokine CXCL7 as a Potential Novel Biomarker for Obstructive Colorectal Cancer

Zhang

et al. 2021

Front. Oncol.

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Due to the lack of typical symptoms and signs and sensitive indicators for early diagnosis of obstructive colorectal cancer (OCRC), it is critically needed to find new novel biomarkers to ameliorate the management of OCRC patients. In this study, 472 blood samples were collected and measured by enzyme-linked immunosorbent assay (ELISA) to investigate the value of serum chemokine ligand 7 (CXCL7) in diagnosis and prognosis for OCRC patients. The median concentrations of CXCL7 in non-OCRC and OCRC were both higher than that in controls (both P < 0.05). Importantly, the median serum concentration of CXCL7 in OCRC was also higher than that in non-OCRC (P < 0.001). In all OCRC patients, the area under the curve (AUC) of CXCL7 was 0.918 with a sensitivity of 86.54% and a specificity of 81.87%. Similarly, the AUC of CXCL7 was 0.684 when the diagnostic test was performed between OCRC and CRC patients. CXCL7 had a higher AUC than other markers. The concentration of CXCL7 in 40 postoperative OCRC patients was higher than normal people and lower than preoperative patients. The median survival time was 62.00 months and the 5-year overall survival (OS) rate of the patients was 51.80% in all 155 OCRC patients. Multivariate Cox proportional hazard regression model analysis showed that high CXCL7 in serum was independent factors associated with poor OS of OCRC patients (HR = 2.216, P = 0.032). These results demonstrate that serum CXCL7 may be a potential biomarker both in diagnosis and prognosis for OCRC patients.

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Impact of a higher fecal immunochemistry test cut-off on pathology detected in subsequent rounds of a colorectal screening program

Cited by 7 publications

References 15 publications

Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program

Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program

One or two faecal immunochemical tests in an organised population-based colorectal cancer screening programme in Murcia (Spain)

Serum Chemokine CXCL7 as a Potential Novel Biomarker for Obstructive Colorectal Cancer

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