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

Li, Shuping J; Seedher, Tara; Sharples, Linda D.; Benton, Sally C; Mathews, Christopher; Gabe, Rhian; Sasieni, Peter; Duffy, Stephen W.

doi:10.1038/s41416-022-01919-y

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…Unlike the independent sector, which can adjust capacity to meet demand, endoscopy resources in public healthcare are often limited. For example, a major obstacle to the planned expansion to younger age‐groups of the English FIT‐based bowel cancer screening programme, where the PPV for cancer is higher (7.1%) 6 and with earlier cancer stage detection, 7 is the lack of available endoscopy capacity.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic yield from symptomatic lower gastrointestinal endoscopy in the UK: A British Society of Gastroenterology analysis using data from the National Endoscopy Database

Beaton,

Sharp,

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundThe value of lower gastrointestinal endoscopy (LGIE; colonoscopy or sigmoidoscopy) relates to its ability to detect clinically relevant findings, predominantly cancers, preneoplastic polyps or inflammatory bowel disease. There are concerns that many LGIEs are performed on low‐risk patients with limited benefit.AimsTo determine the diagnostic outcomes of LGIE for common symptoms.MethodsWe performed a cross‐sectional study of diagnostic LGIE between March 2019 and February 2020 using the UK National Endoscopy Database. We used mixed‐effects logistic regression models, incorporating random (endoscopist) and fixed (symptoms, patient age, and sex) effects upon two dependent variables (large polyp [≥10 mm] and cancer diagnosis). Adjusted positive predictive values (aPPVs) were calculated.ResultsWe analysed 384,510 LGIEs; 33.2% were performed on patients aged under 50 and 53.6% on women. Regarding colonoscopies, the unadjusted PPV for cancer was 1.5% (95% CI: 1.4–1.5); higher for men than women (1.9% vs. 1.1%, p < 0.01). The PPV for large polyps was 3.2% (95% CI: 3.1–3.2). The highest colonoscopy cancer aPPVs were in the over 50s (1.9%) and in those with rectal bleeding (2.5%) or anaemia (2.1%). Cancer aPPVs for other symptoms were <1% despite representing 54.3% of activity. In patients under 50, aPPVs were 0.4% for cancer and 1.6% for large polyps. Results were similar for sigmoidoscopy.ConclusionsMost colonoscopies were performed on patients with low‐risk symptoms, where cancer risk was similar to the general population. Cancer and large polyp yield was highest in elderly patients with rectal bleeding or anaemia, although still fell short of FIT‐based screening yields.

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Section: Introductionmentioning

confidence: 99%

Diagnostic yield from symptomatic lower gastrointestinal endoscopy in the UK: A British Society of Gastroenterology analysis using data from the National Endoscopy Database

Beaton,

Sharp,

et al. 2024

Aliment Pharmacol Ther

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“…A study1 published in the British Journal of Cancer suggests that raising the f-Hb threshold to 180 μg/g would be a better option than changing the gap between screening invitations.…”

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confidence: 99%

Backlog for colonoscopy appointments could be cleared by raising test threshold, study suggests

Wise¹

2022

BMJ

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Maximizing scarce colonoscopy resources: the crucial role of stool-based tests

Coronado,

Bienen,

Burnett-Hartman

et al. 2024

JNCI: Journal of the National Cancer Institute

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During the COVID-19 pandemic, health systems, including federally qualified health centers (FQHCs), experienced disruptions in colorectal cancer (CRC) screening. National organizations called for greater use of at-home stool-based testing followed by colonoscopy for those with abnormal test results to limit (in-person) colonoscopy exams to people with acute symptoms, or who were high-risk. This ‘stool-test-first’ strategy may also be useful for adults with low-risk adenomas who are due for surveillance colonoscopy. We argue that colonoscopy is overused both as a first-line screening method in low and average risk adults and as a surveillance tool among adults with small adenomas. Yet, simultaneously, many people do not receive much-needed colonoscopies. Delivering the right screening tests at intervals that reduce the risk of CRC, while minimizing patient inconvenience and procedural risks, can strengthen health care systems. Risk stratification could improve efficiency of CRC screening, but because models that adequately predict risk are years away from clinical use, we need to optimize use of currently available technology– that is, low-cost fecal testing followed by colonoscopy for those with abnormal test results. The COVID-19 pandemic highlighted the urgent need to adapt to resource constraints around colonoscopies and showed that increased use of stool-based testing was possible. Learning how to adapt to such constraints without sacrificing patients’ health, particularly for patients who receive care at FQHCs, should be a priority for CRC prevention research.

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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

Cited by 4 publications

References 34 publications

Diagnostic yield from symptomatic lower gastrointestinal endoscopy in the UK: A British Society of Gastroenterology analysis using data from the National Endoscopy Database

Diagnostic yield from symptomatic lower gastrointestinal endoscopy in the UK: A British Society of Gastroenterology analysis using data from the National Endoscopy Database

Backlog for colonoscopy appointments could be cleared by raising test threshold, study suggests

Maximizing scarce colonoscopy resources: the crucial role of stool-based tests

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