Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy

Hol, Lieke; Leerdam, Monique E. van; Ballegooijen, Marjolein van; Vuuren, Anneke J. van; Dekken, Herman van; Reijerink, Jacqueline C.; Togt, A C M van der; Habbema, J. Dik F.; Kuipers, Ernst J.

doi:10.1136/gut.2009.177089

Cited by 435 publications

(383 citation statements)

References 35 publications

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“…In einzelnen randomisierten Studien konnte zudem gezeigt werden, dass trotz geringerer Teilnahmerate im Vergleich zum FOBT durch sowohl Sigmoidoskopie [103] als auch Koloskopie [104] in einer intention-to-screen-Analyse mehr fortgeschrittene Neoplasien detektiert werden, was vor allem durch die deutlich höhere Sensitivität für fortgeschrittene Adenome bedingt war. …”

Section: Endoskopische Verfahrenunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

148

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Section: Endoskopische Verfahrenunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

148

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“…25 Additionally, patients in the usual care group received a three-sample guaiac-based FOBT (gFOBT), while the intervention group received a FIT. Completion rates are higher with FIT than gFOBT, 26 , 27 preventing us from separating the effect of outreach from FIT usage. Finally, this study did not stratify patients by prior screening behaviors, despite the fact that never-screened patients may have lower knowledge about CRC screening, tend to rely on physician recommendations, and have negative attitudes toward FOBT.…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

et al. 2015

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INTRODUCTION:Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS: This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66 % were female, 62.1 % were Latino, and 70.7 % were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS: Patients who received outreach were more likely to complete FIT than those in usual care (36.7 % vs. 14.8 %; p<0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION: The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.KEY WORDS: health disparities; cancer prevention; care delivery system.

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“…While the fecal immunochemical test (FIT) is widely used in population-based screening for colorectal neoplasia and is effective in reducing colorectal cancer mortality through early detection, [1][2][3][4][5][6][7][8][9][10][11][12] it has been not yet known whether the detailed information on quantitative fecal hemoglobin concentration (FHbC) available with the FIT might also be of use for predicting the risk of colorectal neoplasia. Unfortunately, because clinical practice is to select subjects with FHbC greater than a set cut-off for further clinical investigation the precise value of FHbC, although measured and often reported, is largely neglected.…”

mentioning

confidence: 99%

A new insight into fecal hemoglobin concentration‐dependent predictor for colorectal neoplasia

Yen

Chen

Chiu

et al. 2014

Intl Journal of Cancer

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We sought to assess how much of the variation in incidence of colorectal neoplasia is explained by baseline fecal hemoglobin concentration (FHbC) and also to assess the additional predictive value of conventional risk factors. We enrolled subjects aged 40 years and over who attended screening for colorectal cancer with the fecal immunochemical test (FIT) in Keelung community-based integrated screening program. The accelerated failure time model was used to train the clinical weights of covariates in the prediction model. Datasets from two external communities were used for external validation. The area under curve (AUC) for the model containing only FHbC was 83.0% (95% CI: 81.5-84.4%), which was considerably greater than the one containing only conventional risk factors (65.8%, 95% CI: 64.2-67.4%). Adding conventional risk factors did not make significant additional contribution (p 5 0.62, AUC 5 83.5%, 95% CI: 82.1-84.9%) to the predictive model with FHbC only. Males showed a stronger linear dose-response relationship than females, yielding gender-specific FHbC predictive models. External validation confirms these results. The high predictive ability supported by a dose-dependent relationship between baseline FHbC and the risk of developing colorectal neoplasia suggests that FHbC may be useful for identifying cases requiring closer postdiagnosis clinical surveillance as well as being an early indicator of colorectal neoplasia risk in the general population. Our findings may also make contribution to the development of the FHbC-guided screening policy but its pros and cons in connection with cost and effectiveness of screening should be evaluated before it can be applied to population-based screening for colorectal cancer.While the fecal immunochemical test (FIT) is widely used in population-based screening for colorectal neoplasia and is effective in reducing colorectal cancer mortality through early detection, 1-12 it has been not yet known whether the detailed information on quantitative fecal hemoglobin concentration (FHbC) available with the FIT might also be of use for predicting the risk of colorectal neoplasia. Unfortunately, because clinical practice is to select subjects with FHbC greater than a set cut-off for further clinical investigation the precise value of FHbC, although measured and often reported, is largely neglected. The previous study reported that baseline FHbC can be predictive of incident colorectal neoplasia among screening participants who test negative at the first screen. 13 Nonetheless, it is not possible to fully investigate the relationship between risk of developing colorectal neoplasia and having a high FHbC because the natural history of the disease in those with FHbC levels above the cut off is interrupted owing to the administration of medical regime. To assess the predictive power of FHbC as a measure of risk of colorectal neoplasia one must develop a risk model based on FHbC (measured as a continuous variable at baseline in those testing both negative and positive according t...

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Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy

Cited by 435 publications

References 35 publications

S3-Leitlinie – Kolorektales Karzinom

S3-Leitlinie – Kolorektales Karzinom

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

A new insight into fecal hemoglobin concentration‐dependent predictor for colorectal neoplasia

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