Test, episode, and programme sensitivities of screening for colorectal cancer as a public health policy in Finland: experimental design

Abstract

Objectives To report the sensitivities of the faecal occult blood test, screening episode, and screening programme for colorectal cancer and the benefits of applying a randomised design at the implementation phase of a new public health policy.Design Experimental design incorporated in public health evaluation using randomisation at individual level in the target population.Setting 161 of the 431 Finnish municipalities in 2004-6.Participants 106 000 adults randomised to screening or control arms. In total, 52 998 adults aged 60-64 in the screening arm received faecal occult blood test kits.Main outcome measures Test, episode, and programme sensitivities estimated by the incidence method and corrected for selective attendance and overdiagnosis.Results The response for screening was high overall (70.8%), and significantly better in women (78.1%) than in men (63.3%). The incidence of cancer in the controls was somewhat higher in men than in women (103 v 93 per 100 000 person years), which was not true for interval cancers (42 v 49 per 100 000 person years). The sensitivity of the faecal occult blood test was 54.6%. Only a few interval cancers were detected among those with positive test results, hence the episode sensitivity of 51.3% was close to the test sensitivity. At the population level the sensitivity of the programme was 37.5%.Conclusions Although relatively low, the sensitivity of screening for colorectal cancer with the faecal occult blood test in Finland was adequate. An experimental design is a prerequisite for evaluation of such a screening programme because the effectiveness of preventing deaths is likely to be small and results may otherwise remain inconclusive. Thus, screening for colorectal cancer using any primary test modality should be launched in a public health programme with randomisation of the target population at the implementation phase.

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

“…Interaction between gender and FHbC level either with ordinal or continuous data type was also tested as the previous study has shown the sensitivity of guaiac fecal occult blood test (gFOBT) was poorer in females than males. 22,23 Because of the early detection of colorectal cancer or adenoma for those with FHbC 100 ng/ ml (via referral for colonoscopy), we adjusted the time to event for these cases by a correction factor, the overall follow-up time divided by average interval from age of 30 years to age at first screen in this cohort (please see the Supporting Information Appendix for further details). The regression coefficients from the AFT models were taken as clinical weights.…”

“…Finnish also reported higher test sensitivity in men than women using incident cancer data from their colorectal cancer screening program. 23 Studies for different cutoff values by gender are worthy of being investigated by the application of our gender-specific predictive model in the future.…”

Colorectal cancer screening in Europe

“…Individuals in the screening group were mailed a gFOBT test at intervals of 2 years. The Finnish program shows a high level of compliance of the target population (70.8%), particularly for females [33] . In the Netherlands, the optimum screening strategy is still being developed.…”

Screening for Colorectal Cance

“…Individuals in the screening group were mailed a gFOBT test at intervals of 2 years. The finish program shows a high level compliance of the target population (70.8%), particularly for females [9] Poland is the only state at the moment using colonoscopy as the only screening method, without the alternative of of FOBTs. An opportunistic screening programme was initiated in 2000, and by 2005, this had grown to 57 centres across Poland.…”