Screening for colorectal cancer in Chinese: Comparison of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy

Sung, Joseph J.Y.; Chan, Francis K.L.; Leung, Wai K.; Wu, Justin C.Y.; Lau, James Y.; Ching, Jessica; To, KF; Lee, Yuk T.; Luk, Yiu Wing; Kung, Nelson N.S.; Kwok, S.P.Y.; Li, Michael K.W.; Chung, Shao-Wei

doi:10.1053/gast.2003.50090

Cited by 156 publications

(128 citation statements)

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“…Furthermore, one of the FOBT studies included 97% men, which hinders a direct comparison (21). Our data show that stool testing only marginally increases sensitivity when combined with sigmoidoscopy, in line with previous findings (10,21,22). FIT lacked sensitivity in subjects with proximal advanced and/or adenomas only, an observation in line with those of Morikawa and colleagues (13).…”

Section: Discussionsupporting

confidence: 86%

“…Sample size calculation was conducted on the basis of previously reported prevalence rates for advanced adenomas in average risk groups (20), as well as sensitivities of FIT (10, 13) and sigmoidoscopy (10,21,22) for detection of subjects with advanced adenomas. With an a of 0.05 and 80% power, a sample of at least 300 subjects was needed to detect a minimal expected difference of 30% in sensitivity for detection of advanced adenomas between FIT and sigmoidoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Four other studies have compared FOBT and/or FIT and sigmoidoscopy with colonoscopy findings (9,10,21,22), of which 2 used a single FIT. Graser and colleagues reported a similar difference of 51% FIT and sigmoidoscopy for the detection of advanced adenomas (10) whereas Cheng and colleagues (9) and the 2 remaining studies using guaiac-based FOBT did not report on sensitivities for advanced adenomas separately (21,22). Furthermore, one of the FOBT studies included 97% men, which hinders a direct comparison (21).…”

Section: Discussionmentioning

confidence: 99%

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Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

Bakker

Jonkers

Sanduleanu

et al. 2011

Cancer Prevention Research

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Given the current increase in colorectal cancer screening, information on performance of screening tests is needed, especially in groups with a presumed lower test performance. We compared test performance of immunologic fecal occult blood testing (FIT) and pseudosigmoidoscopy with colonoscopy for detection of advanced adenomas in an average risk screening population. In addition, we explored the influence of gender, age, and location on test performance. FIT was collected prior to colonoscopy with a 50 ng/mL cutoff point. FIT results and complete colonoscopy findings were available from 329 subjects (mean age: 54.6 AE 3.7 years, 58.4% women). Advanced adenomas were detected in 38 (11.6%) of 329 subjects. Sensitivity for advanced adenomas of FIT and sigmoidoscopy were 15.8% (95% CI: 6.0-31.3) and 73.7% (95% CI: 56.9-86.6), respectively. No sensitivity improvement was obtained using the combination of sigmoidoscopy and FIT. Mean fecal hemoglobin in FIT positives was significantly lower for participants with only proximal adenomas versus those with distal ones (P ¼ 0.008), for women versus men (P ¼ 0.023), and for younger (<55 years) versus older (!55 years) subjects (P ¼ 0.029). Sensitivities of FIT were 0.0% (95% CI: 0.0-30.9) in subjects with only proximal versus 21.4% (95% CI: 8.3-41.0) in those with distal nonadvanced adenomas; 5.3% (95% CI: 0.0-26.0) in women versus 26.3% (95% CI: 9.2-51.2) in men; 9.5% (95% CI: 1.2-30.4) in younger versus 23.5% (95% CI: 6.8-49.9) in older subjects. Sigmoidoscopy had a significantly higher sensitivity for advanced adenomas than FIT. A single FIT showed very low sensitivity, especially in subjects with only proximal nonadvanced adenomas, in women, and in younger subjects. This points to the existence of "low" FIT performance in subgroups and the need for more tailored screening strategies. Cancer Prev Res; 4(10); 1563-71. Ó2011 AACR.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

Bakker

Jonkers

Sanduleanu

et al. 2011

Cancer Prevention Research

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“…The studies that attempted to reduce verification bias are listed in Table 2. [51][52][53][54][55][56][57][58][59][60] These 10 studies included 185 subjects with colorectal cancer and 31,804 controls. Seven studies reduced verification bias by performing colonoscopy on all of the potential subjects 51,54-56,58-60 while 3 studies used longitudinal follow-up for at least 2 years.…”

Section: Included Studiesmentioning

confidence: 99%

Effect of Verification Bias on the Sensitivity of Fecal Occult Blood Testing: a Meta-Analysis

Rosman

Korsten

2010

J GEN INTERN MED

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OBJECTIVES: There is controversy regarding the sensitivity of fecal occult blood tests (FOBT) for detecting colorectal cancer. Many of the published studies failed to correct for verification bias which may have increased the sensitivity. METHODS: A meta-analysis of published studies evaluating the sensitivity and specificity of chemical-based FOBT for colorectal cancer was performed. Studies were included if both cancer and control subjects underwent confirmatory testing. We also included studies that attempted to correct for verification bias by either performing colonoscopy on all subjects regardless of the FOBT result or by using longitudinal follow-up. We then compared the sensitivity, specificity, and other diagnostic characteristics of the studies that attempted to correct for verification (n=10) vs. those that did not correct for this bias (n=19). RESULTS: The pooled sensitivity of guaiac-based FOBT for colorectal cancer of studies without verification bias was significantly lower than those studies with this bias There was no significant difference in the area under the summary receiver operating characteristic curves. More sensitive chemical-based FOBT methods (e.g., Hemoccult® SENSA®) had a higher sensitivity but a lower specificity than standard guaiac methods. CONCLUSIONS: The sensitivity of guaiac-based FOBT for colorectal cancer has been overestimated as a result of verification bias. This test may not be sensitive enough to serve as an effective screening option for colorectal cancer.KEY WORDS: fecal occult blood; guaiac; colorectal cancer; summary receiver operating characteristic curve; meta-analysis.

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“…20 As the screening cohort did not receive FS, the sensitivity and specificity of FS was assumed to be 75-80 and 60-90%, respectively, according to published literature. 21,22 The population was expected to develop CRC according to the age-specific incidence rates of CRC in Hong Kong 15 in the absence of CRC screening. We made reference to a study conducted in Japan 23 and three landmark randomized controlled trials, [24][25][26] and assumed that FIT could reduce CRC incidence by 33%.…”

Section: Clinical Transition Probabilitiesmentioning

confidence: 99%

Screening strategies for colorectal cancer among patients with nonalcoholic fatty liver disease and family history

Wong

Ching

Chan

et al. 2015

Intl Journal of Cancer

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Patients with nonalcoholic fatty liver disease (NAFLD) and family history of colorectal cancer (CRC) are at higher risks but how they should be screened remains uncertain. Hence, we evaluated the cost-effectiveness of CRC screening among patients with NAFLD and family history by different strategies. A hypothetical population of 100,000 subjects aged 40-75 years receive: (i) yearly fecal immunochemical test (FIT) at 50 years; (ii) flexible sigmoidoscopy (FS) every 5 years at 50 years; (iii) colonoscopy 10 yearly at 50 years; (iv) colonoscopy 10 yearly at 50 years among those with family history/NAFLD and yearly FIT at 50 years among those without; (v) colonoscopy 10 yearly at 40 years among those with family history/NAFLD and yearly FIT at 50 years among those without and (vi) colonoscopy 10 yearly at 40 years among those with family history/NAFLD and colonoscopy 10 yearly at 50 years among those without. The incremental cost-effectiveness ratio (ICER) was studied by Markov modeling. It was found that colonoscopy, FS and FIT reduced incidence of CRC by 49.5, 26.3 and 23.6%, respectively. Using strategies 4, 5 and 6, the corresponding reduction in CRC incidence was 29.9, 30.9 and 69.3% for family history, and 33.2, 34.7 and 69.8% for NAFLD. Compared with no screening, strategies 4 (US$1,018/life-year saved) and 5 (US$7,485) for family history offered the lowest ICER, whilst strategy 4 (US$5,877) for NAFLD was the most cost-effective. These findings were robust when assessed with a wide range of deterministic sensitivity analyses around the base case. These indicated that screening patients with family history or NAFLD by colonoscopy at 50 years was economically favorable.Colorectal Cancer (CRC) presents a leading global burden of disease, accounting for 10% of all malignancies and 8% of cancer mortality worldwide. 1 Its incidence is rising rapidly in both Western and Asia Pacific countries. 2 Screening was found to be effective in reducing CRC-related mortality by 33, 40 and 56% using fecal occult blood tests (FOBTs), flexible sigmoidoscopy (FS) and colonoscopy, respectively. 3,4 Guidelines from Western and Asian countries 5,6 recommend population-based CRC screening in average-risk subjects aged 50-75 years.Fecal immunochemical tests (FITs) and FS are widely used in most countries as primary screening tools. FS is gaining popularity in European countries, whilst colonoscopy is becoming the predominant mode of screening in the United States. 7 None of the screening tests, however, appears optimal across all settings, and it is still inconclusive which of the available options could offer the best balance of costs and benefits.It has been reported that first-degree relatives (FDRs) of patients with CRC have a twofold increased risk of developing CRC compared to the general population. 8,9 Ng et al. recently found that siblings of CRC patients had a strong and significantly increased risk of advanced neoplasia than siblings of healthy individuals. 10 In addition, Wong et al. reported that patients with nonalcoholic...

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Screening for colorectal cancer in Chinese: Comparison of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy

Cited by 156 publications

References 18 publications

Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

Test Performance of Immunologic Fecal Occult Blood Testing and Sigmoidoscopy Compared with Primary Colonoscopy Screening for Colorectal Advanced Adenomas

Effect of Verification Bias on the Sensitivity of Fecal Occult Blood Testing: a Meta-Analysis

Screening strategies for colorectal cancer among patients with nonalcoholic fatty liver disease and family history

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