Interval cancers in a population-based screening program for colorectal cancer with gender-specific cut-off levels for fecal immunochemical test

Wilén, Hanna Ribbing; Saraste, Deborah; Blom, Johannes

doi:10.1177/09691413221085218

Cited by 5 publications

(10 citation statements)

References 32 publications

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“…When advanced‐stage screen‐detected CRCs in the subsequent round are included in the calculation, this would (somewhat) reduce the FIT sensitivity. The evaluation of FIT‐based screening programs does not yet take this phenomenon into account when estimating the sensitivity of FIT 15,17‐21 . Cancer screening researchers should discuss and reach consensus on the calculation of FIT sensitivity, similar to the consensus statement on post‐colonoscopy cancers 22 …”

Section: Discussionmentioning

confidence: 99%

“…The evaluation of FIT‐based screening programs does not yet take this phenomenon into account when estimating the sensitivity of FIT. 15 , 17 , 18 , 19 , 20 , 21 Cancer screening researchers should discuss and reach consensus on the calculation of FIT sensitivity, similar to the consensus statement on post‐colonoscopy cancers. 22 …”

Section: Discussionmentioning

confidence: 99%

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Factors associated with interval colorectal cancer after negative FIT: Results of two screening rounds in the Dutch FIT‐based CRC screening program

Breekveldt

Toes‐Zoutendijk

Schootbrugge-Vandermeer

et al. 2022

Intl Journal of Cancer

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The interval colorectal cancer (CRC) rate after negative fecal immunochemical testing (FIT) is an important quality indicator of CRC screening programs. We analyzed the outcomes of two rounds of the FIT-based CRC screening program in the Netherlands, using data from individuals who participated in FIT-screening from 2014 to 2017. Data of individuals with one prior negative FIT (first round) or two prior negative FITs (first and second round) were included. Outcomes included the incidence of interval CRC in FIT-negative participants (<47 μg Hb/g feces [μg/g]), FIT-sensitivity, and the probability of detecting an interval CRC by fecal hemoglobin concentration (f-Hb). FIT-sensitivity was estimated using the detection method and the proportional incidence method (based on expected CRC incidence). Logistic regression analysis was performed to estimate whether f-Hb affects probability of detecting interval CRC, adjusted for sex-and age-differences. Incidence of interval CRC was 10.4 per 10 000 participants after the first and 9.6 after the second screening round. FIT-sensitivity based on the detection method was 84.4% (95%CI 83.8-85.0) in the first and 73.5% (95% CI 71.8-75.2) in the second screening round.The proportional incidence method resulted in a FIT-sensitivity of 76.4% ) in the first and 79.1% (95%CI 73.7-85.3) in the second screening round.After one negative FIT, participants with f-Hb just below the cut-off (>40-46.9 μg/g) had a higher probability of detecting an interval CRC (OR 16.9; 95%CI: 14.0-20.4) than had participants with unmeasurable f-Hb (0-2.6 μg/g). After two screening rounds, the odds ratio for interval CRC was 12.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors associated with interval colorectal cancer after negative FIT: Results of two screening rounds in the Dutch FIT‐based CRC screening program

Breekveldt

Toes‐Zoutendijk

Schootbrugge-Vandermeer

et al. 2022

Intl Journal of Cancer

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“…In addition, the Swedish group have recently shown that using different f-Hb thresholds, the clinical sensitivity was higher, and the interval cancer rate was lower in women than in men. 29 …”

Section: Discussionmentioning

confidence: 99%

Sex variation in colorectal cancer mortality: trends and implications for screening

Clark

Fraser

Strachan

et al. 2023

European Journal of Public Health

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Background Colorectal cancer (CRC) screening using faecal tests reduces disease-specific mortality. To investigate mortality and its association with sex, rates in women and men, and in different age ranges, were examined, before and after screening began in Scotland. Methods From 1990–99, no structured screening existed. Three pilots ran from 2000 to 2007 and subsequent full roll-out completed in 2009. Crude mortality rates for 1990–2020 were calculated relative to Scottish population estimates, and age–sex standardized rates calculated for all, pre-screening (<50 years), screening (5–74 years) and post-screening (>74 years) age ranges. Results CRC mortality declined from 1990 to 2020, but not linearly, and differed between sexes. In women, 1990–99 showed a steady decline [average annual percentage change (AAPC): −2.1%, 95% confidence interval (CI): −2.8% to −1.4%], but a less marked decline after 2000 (AAPC: −0.7%, 95% CI: −0.9% to −0.4%). In men, no clear decline was seen from 1990 to 1999 (AAPC: −0.4%, 95% CI: −1.1% to 0.4%), but mortality declined from 2000 to 2020 (AAPC: −1.7%, 95% CI: −1.9% to −1.5%). This pattern was exaggerated in the screening age ranges. For 2000–20, the overall reduction in mortality was less in women and in the screening age range. In the post-screening age range, reductions were smaller, but an increase was seen in the pre-screening age range, greater in women. Conclusions CRC mortality fell during 1990–2020, but the decline differed markedly between sexes, indicating a larger beneficial effect of screening on CRC mortality in men compared to women: use of different thresholds for the sexes might lead to equality.

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“…As FIT ICs are more often proximally located compared to SD CRCs, this could have underestimated the differences in men and women. 8,18,33 Secondly, misclassification of FIT ICs and SD CRCs could have occurred in the second round since this was discovered in the first round. A few with FIT IC in the first round were in fact invited again slightly earlier than 24 months after previous invitation, and thus reclassified to SD CRC in the second round.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17] We recently reported the first screening round in the Swedish population-based program of Stockholm-Gotland applying cut-off levels of 40 µg/g in women and 80 µg/g in men, and demonstrated a higher test sensitivity in women than in men and a tendency towards a higher IC rate in men when compared to the background CRC incidence. 18 The aim of this study was to assess the IC incidence and test sensitivity in men and women after two screening rounds to achieve a higher precision in the estimates. A secondary aim was to investigate FIT levels in men and women diagnosed with CRC including participants with FIT levels below 80 µg/g.…”

Section: Introductionmentioning

confidence: 99%

Interval cancer after two rounds of a Swedish population-based screening program using gender-specific cut-off levels in fecal immunochemical test

Wilén

Blom

2023

J Med Screen

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Objective To evaluate interval cancer (IC) after two screening rounds of the Swedish population-based screening program of Stockholm–Gotland applying gender-specific cut-off levels in the fecal immunochemical test (FIT). Methods All 60- to 69-year-olds invited to screening 2015–2019 were included. The cut-off level for a positive test was 40 µg/g in women and 80 µg/g in men. Screening-detected colorectal cancers (SD CRCs) and ICs were verified in the Swedish Colorectal Cancer Register, and the follow-up time was two years from invitation. The test sensitivity, the IC rate (ICs per 10,000 screening negatives) and the IC incidence (ICs per 100,000 person-years) relative to the background CRC incidence were assessed by gender and age. The FIT levels were compared in men and women for CRCs diagnosed within one year of the sample. Results In the second screening round, 229,187 were invited, and SD CRCs and ICs were diagnosed in 193 and 144, respectively. The IC rate was 8.9 (7.4–10.3) and test sensitivity 0.61 (0.55–0.66), and was similar in men and women. For two screening rounds, the IC rate was significantly higher in men than in women, but the IC incidence/ background CRC incidence was similar in both genders. The FIT levels in female participants with CRC were significantly lower overall, and in early-staged CRCs as compared to men, and proximal localization was more common in women. In multivariable analysis, FIT levels were significantly lower in proximal CRCs. Conclusion Over two rounds, the IC incidence relative to the background CRC incidence was similar in men and women supporting a gender-specific screening strategy. The results could be explained by lower FIT levels in women due to proximal CRC localization.

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Interval cancers in a population-based screening program for colorectal cancer with gender-specific cut-off levels for fecal immunochemical test

Cited by 5 publications

References 32 publications

Factors associated with interval colorectal cancer after negative FIT: Results of two screening rounds in the Dutch FIT‐based CRC screening program

Factors associated with interval colorectal cancer after negative FIT: Results of two screening rounds in the Dutch FIT‐based CRC screening program

Sex variation in colorectal cancer mortality: trends and implications for screening

Interval cancer after two rounds of a Swedish population-based screening program using gender-specific cut-off levels in fecal immunochemical test

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