Selecting a Cut-off for Colorectal Cancer Screening With a Fecal Immunochemical Test

Brenner, Hermann; Werner, Simone

doi:10.1038/ctg.2017.37

Cited by 25 publications

(25 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most studies evaluating the quality of CRCSP based on FIT use a single cut-off point for the entire target population [12][13][14][15][16]. A study found that cut-off points above 25μg / g hardly affects the positive predictive value of the test [12].…”

Section: Introductionmentioning

confidence: 99%

Optimal cut-off value for detecting colorectal cancer with fecal immunochemical tests according to age and sex

et al. 2021

View full text Add to dashboard Cite

In the fecal immunological test, a suitable cut-off value may be selected to classify results as either positive or negative. Our aim is to estimate the optimal cut-off value for detecting colorectal cancer in different age and sex groups. This is a multicentric retrospective cohort study of participants in CRC screening programs with FIT between 2006 and 2012. A total of 545,505 participations were analyzed. Cancers diagnosed outside of the program were identified after a negative test result (IC_test) up until 2014. The Wilcoxon test was used to compare fecal hemoglobin levels. ROC curves were used to identify the optimal cut-off value for each age and sex group. Screening program results were estimated for different cut-off values. The results show that the Hb concentration was higher in colorectal cancer (average = 179.6μg/g) vs. false positives (average = 55.2μg/g), in IC_test (average = 3.1μg/g) vs. true negatives (average = 0μg/g), and in men (average = 166.2μg/g) vs. women (average = 140.2μg/g) with colorectal cancer. The optimal cut-off values for women were 18.3μg/g (50-59y) and 14.6μg/g (60-69y), and 16.8μg/g (50-59y) and 19.9μg/g (60-69y) for men. Using different cut-off values for each age and sex group lead to a decrease in the IC_test rate compared to the 20μg/g cut-off value (from 0.40‰ to 0.37‰) and an increase in the false positive rate (from 6.45% to 6.99%). Moreover, test sensitivity improved (90.7%), especially in men and women aged 50-59y (89.4%; 90%) and women aged 60-69y (90.2%). In conclusion, the optimal cut-off value varies for different sex and age groups and the use of an optimal cut-off value for each group improves sensitivity and leads to a small decrease in IC_tests, but also to a larger increase in false positives.

show abstract

Section: Introductionmentioning

confidence: 99%

Optimal cut-off value for detecting colorectal cancer with fecal immunochemical tests according to age and sex

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In the Dutch screening program, the cut-off value was increased from 15 to 47 µg hgb./g feces due to higher participation rate and lower positive predictive value (PPV) than predicted 8. Brenner et al, argue that a cut-off value of 15 µg hgb./g feces would ensure a specificity of 95% and a PPV of 47% for the detection of advanced neoplasia during subsequent diagnostic OC 9…”

Section: Introductionmentioning

confidence: 99%

<p>Time to colonoscopy, cancer probability, and precursor lesions in the Danish colorectal cancer screening program</p>

Kaalby¹,

Rasmussen²,

Zimmermann-Nielsen³

et al. 2019

CLEP

View full text Add to dashboard Cite

Purpose The aim of this study was to investigate the effect of response time from the Fecal Immunochemical Test (FIT) based screening invitation to the conclusive screening Optical Colonoscopy (OC) on the risk of detecting colorectal cancer (CRC), advanced stage disease and precursor lesions. Patients and methods We used a cross-sectional study design and included all 62,554 screening participants registered in the Danish Colorectal Cancer Screening Database who tested FIT-positive between March 2014 and December 2016. The main exposure was response time, measured as the time from initial invitation to the conclusive OC. Our main outcomes were the probability of being diagnosed with CRC, advanced stage disease or precursor lesions. Results Of the 62,554 FIT-positive participants, 53,171 (85%) received an OC and were eligible for analysis (median age 63.7 years, 56% men). In this group, 3,639 cancers were registered, 2,890 of which were registered with a defined stage of disease (79%), and 1,042 (36%) of these were advanced stage (UICC III & IV). In addition, 17,732 high-risk and 10,605 low-risk adenomas were identified. Compared to participants receiving the conclusive examination within 30 days, those receiving the examination more than 90 days after initial invitation were 3.49 times more likely to be diagnosed with any CRC (OR 3.49 [95% CI, 3.13–3.89]) and 2.10 times more likely to have advanced stage disease (OR 2.10 [95% CI, 1.73–2.56]). Those waiting for the longest were also more likely to have one or more high-risk adenomas (OR 1.59 [95% CI, 1.50–1.68]). Conclusion Increased screening response time was associated with a higher probability of detecting high-risk adenomas, any stage CRC and advanced stage cancer. More research is needed to explain what causes these associations.

show abstract

“…The most important variable of FIT performance is the threshold for a positive result. 43,46,47 Pooled data suggests that a cutoff threshold of 20 μg of hemoglobin per gram of stool has the best performance characteristics, with a sensitivity and specificity for CRC detection of 89% and 91%, respectively. 46 However, the sensitivity, specificity, and positive predictive value of the test vary considerably with different cutoff thresholds, and the variation has a large impact on the use of endoscopic resources.…”

Section: Crc Screening Modalitiesmentioning

confidence: 99%

“…From a cutoff of 20 μg/g to 50 μg/g, the sensitivity for advanced neoplasia detection decreases by 39%, and the rate of test positivity almost halves. 47 A diagnostic FIT threshold of less than 20 μg/g is currently recommended by the US Multi-Society Task Force on CRC; however, the optimal threshold remains uncertain and is not directly discussed in most guidelines. In LMICs, such as Nigeria, the cutoff must be tailored to the limited endoscopy capacity available to investigate a positive result.…”

Section: Crc Screening Modalitiesmentioning

confidence: 99%

See 1 more Smart Citation

Is Colorectal Cancer Screening Appropriate in Nigeria?

Knapp

Alatise

Olasehinde

et al. 2019

JGO

View full text Add to dashboard Cite

PURPOSE The global burden of colorectal cancer (CRC) will continue to increase for the foreseeable future, largely driven by increasing incidence and mortality in low- and middle-income countries (LMICs) such as Nigeria. METHODS We used the Wilson-Jungner framework (1968) to review the literature relevant to CRC screening in Nigeria and propose areas for future research and investment. RESULTS Screening is effective when the condition sought is both important and treatable within the system under evaluation. The incidence of CRC is likely increasing, although the exact burden of disease in Nigeria remains poorly understood and access to definitive diagnosis and treatment has not been systematically quantified. In high-income countries (HICs), CRC screening builds on a well-known natural history. In Nigeria, a higher proportion of CRC seems to demonstrate microsatellite instability, which is dissimilar to the molecular profile in HICs. Prospective trials, tissue banking, and next-generation sequencing should be leveraged to better understand these potential differences and the implications for screening. Fecal immunochemical test for hemoglobin (FIT) is recommended for LMICs that are considering CRC screening. However, FIT has not been validated in Nigeria, and questions about the impact of high ambient temperature, endemic parasitic infection, and feasibility remain unanswered. Prospective trials are needed to validate the efficacy of stool-based screening, and these trials should consider concomitant ova and parasite testing. CONCLUSION Using the Wilson-Jungner framework, additional work is needed before organized CRC screening will be effective in Nigeria. These deficits can be addressed without missing the window to mitigate the increasing burden of CRC in the medium to long term.

show abstract

Selecting a Cut-off for Colorectal Cancer Screening With a Fecal Immunochemical Test

Cited by 25 publications

References 38 publications

Optimal cut-off value for detecting colorectal cancer with fecal immunochemical tests according to age and sex

Optimal cut-off value for detecting colorectal cancer with fecal immunochemical tests according to age and sex

<p>Time to colonoscopy, cancer probability, and precursor lesions in the Danish colorectal cancer screening program</p>

Is Colorectal Cancer Screening Appropriate in Nigeria?

Contact Info

Product

Resources

About