The Global Paradigm Shift in Screening for Colorectal Cancer

Young, Graeme P.; Rabeneck, Linda; Winawer, Sidney J.

doi:10.1053/j.gastro.2019.02.006

Cited by 65 publications

(75 citation statements)

References 32 publications

(23 reference statements)

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“…Implementation of CRC screening programs in communities allows early detection of colonic neoplasm(s) to lower the treatment need, morbidity, and mortality [6]. However, CRC screening programs in different countries differ in their approach [7]. These programs can be broadly divided by structured opportunistic and population-based organised (pilot) screening programs (Table 1) [4].…”

Section: Colorectal Cancer Screening Programmentioning

confidence: 99%

Non-Invasive Colorectal Cancer Screening: An Overview

Tepus¹,

Yau²

2020

Gastrointest Tumors

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Background: Colorectal cancer (CRC) follows a protracted stepwise progression, from benign adenomas to malignant adenocarcinomas. If detected early, 90% of deaths are preventable. However, CRC is asymptomatic in its early-stage and arises sporadically within the population. Therefore, CRC screening is a public health priority. Summary: Faecal immunochemical test (FIT) is gradually replacing guaiac faecal occult blood test and is now the most commonly used screening tool for CRC screening program globally. However, FIT is still limited by the haemoglobin degradation and the intermittent bleeding patterns, so that one in four CRC cases are still diagnosed in a late stage, leading to poor prognosis. A multi-target stool DNA test (Cologuard, a combination of NDRG4 and BMP3 DNA methylation, KRAS mutations, and haemoglobin) and a plasma SEPT9 DNA methylation test (Epi proColon) are non-invasive tools also approved by the US FDA, but those screening approaches are not cost-effective, and the detection accuracies remain unsatisfactory. In addition to the approved tests, faecal-/bloodbased microRNA and CRC-related gut microbiome screening markers are under development, with work ongoing to find the best combination of molecular biomarkers which maximise the screening sensitivity and specificity. Key Message: Maximising the detection accuracy with a cost-effective approach for non-invasive CRC screening is urgently needed to further reduce the incidence of CRC and associated mortality rates.

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Section: Colorectal Cancer Screening Programmentioning

confidence: 99%

Non-Invasive Colorectal Cancer Screening: An Overview

Tepus¹,

Yau²

2020

Gastrointest Tumors

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“…Screening has proven effective in reducing mortality from and the incidence of colorectal cancer (CRC), so that population CRC screening programmes have been launched in recent decades in many regions with moderate-to-high CRC incidence. [1][2][3][4][5][6] The faecal immunochemical test (FIT) is currently one of the most popular tests for population CRC screening, especially in regions where colonoscopy capacity or workforce is constrained. Its effectiveness in reducing CRC mortality or incidence has been demonstrated in several cohort studies from those existent programmes.…”

Section: Introductionmentioning

confidence: 99%

Faecal immunochemical test after negative colonoscopy may reduce the risk of incident colorectal cancer in a population-based screening programme

Peng

Hsu

Wang

et al. 2020

Gut

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ObjectiveSubjects with a positive faecal immunochemical test (FIT) have a much higher likelihood of advanced neoplasms than the general population. Whether FIT-positive subjects with negative colonoscopy should receive subsequent FIT screening remain unclear.DesignSubjects with a negative colonoscopy after positive FIT in the first screening in the Taiwanese Colorectal Cancer (CRC) Screening Program 2004–2009 were followed until the end of 2014. CRC incidence was compared between those who did and did not receive subsequent FIT screening. Cox regression analysis was conducted, adjusting for major confounders to investigate whether subsequent FIT was associated with lower risk of incident CRC.ResultsThe study cohort was comprised of 9179 subjects who had negative diagnostic colonoscopy after positive FIT in 2004–2009, of whom 6195 received subsequent FIT during the study period. The CRC incidence (per 1000 person years) was 1.34 in those who received subsequent FIT and 2.69 in those who did not, with corresponding adjusted HR (aHR) of 0.47 (95% CI 0.31 to 0.71). Lower adenoma detection rate of diagnostic colonoscopy was associated with higher risk of incident CRC but became non-significant in multivariable analysis after adjustment for subsequent FIT. Higher baseline faecal haemoglobin concentration (FHbC, μg haemoglobin/g faeces) was associated with increased risk of incident CRC (reference: FHbC=20–39; aHR=1.93 (1.04–3.56), 0.95 (0.45–2.00), 2.26 (1.16–4.43) and 2.44 (1.44–4.12) for FHbC=40–59, 60–99, 100–149 and ≥150, respectively).ConclusionSubsequent FIT should be scheduled after negative colonoscopy to detect missed neoplasms and reduce the risk of incident CRC in a national FIT screening programme.

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“…Many countries use faecal occult blood tests (FOBT) for colorectalcancer (CRC) screening in the form of either guaiac FOBT (gFOBT) or the newer faecal immunochemical tests for haemoglobin (FIT). 1 The development of quantitative FIT has improved detection of colorectal neoplasia and is now…”

Section: Introductionmentioning

confidence: 99%

“…Open access the predominant FOBT screening technology used worldwide. [1][2][3] Recent studies have shown that FIT reduces CRC mortality as well as incidence through detection and removal of early stage cancers or precancerous adenomas. [4][5][6] Quantitation of faecal haemoglobin concentration (f-Hb) has provided flexibility for screening programmes to choose the criterion value (the 'cut-off' f-Hb at which a test is reported as positive) that triggers diagnostic colonoscopy.…”

mentioning

confidence: 99%

Detection of advanced colorectal neoplasia and relative colonoscopy workloads using quantitative faecal immunochemical tests: an observational study exploring the effects of simultaneous adjustment of both sample number and test positivity threshold

Young

Woodman

Symonds

2020

BMJ Open Gastroenterol

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ObjectiveWhen screening for colorectal cancer (CRC) using quantitative faecal immunochemical tests (FIT), test parameters requiring consideration are the faecal haemoglobin concentration (f-Hb) positivity cut-off and the number of stools sampled. This observational study explored variation in f-Hb between samples and the relationship between sensitivity for advanced neoplasia (AN, cancer or advanced adenoma) and colonoscopy workload across a range of independently-adjusted parameter combinations.DesignQuantitative FIT data (OC-Sensor) were accessed from individuals undergoing personalised colonoscopic screening with an offer of 2-sample FIT in the intervening years. We estimated variation in f-Hb between samples in 12 710 completing 2-sample FIT, plus test positivity rates (colonoscopy workload) and sensitivity for AN according to parameter combinations in 4037 instances where FIT was done in the year preceding colonoscopy.ResultsThere was large within-subject variability between samples, with the ratio for the second to the first sample f-Hb ranging up to 18-fold for all cases, and up to 56-fold for AN cases. Sensitivity for AN was greatest at lower f-Hb cut-offs and/or using 2-sample FIT. Colonoscopy workload varied according to how parameters were combined. Using different cut-offs for 1-sample FIT and 2-sample FIT to return similar sensitivity, workload was less with 2-sample FIT when the sensitivity goal exceeded 35%.ConclusionVariation in f-Hb between samples is such that both parameters are crucial determinants of sensitivity and workload; independent adjustment of each should be considered. The 2-sample FIT approach is best for detecting advanced adenomas as well as CRC provided that the colonoscopy workload is feasible.

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The Global Paradigm Shift in Screening for Colorectal Cancer

Cited by 65 publications

References 32 publications

Non-Invasive Colorectal Cancer Screening: An Overview

Non-Invasive Colorectal Cancer Screening: An Overview

Faecal immunochemical test after negative colonoscopy may reduce the risk of incident colorectal cancer in a population-based screening programme

Detection of advanced colorectal neoplasia and relative colonoscopy workloads using quantitative faecal immunochemical tests: an observational study exploring the effects of simultaneous adjustment of both sample number and test positivity threshold

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