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Yen AMF, Hsu CY, Lin TY, Su CW, Chiu HM, Chen THH, Chen SLS. Precision Colorectal Cancer Fecal Immunological Test Screening With Fecal-Hemoglobin-Concentration-Guided Interscreening Intervals. JAMA Oncol 2024:2818569. [PMID: 38722640 PMCID: PMC11082752 DOI: 10.1001/jamaoncol.2024.0961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/28/2023] [Indexed: 05/12/2024]
Abstract
Importance Given a gradient relationship between fecal hemoglobin (f-Hb) concentration and colorectal neoplasia demonstrated previously, using f-Hb-guided interscreening interval has increasingly gained attention in population-based fecal immunological test (FIT), but it is very rare to address how to implement such a precision strategy and whether it can economize the use of FIT and colonoscopy. Objective To demonstrate the applicability of personalized colorectal cancer (CRC) screening with f-Hb-guided screening intervals to reduce the number of FITs and colonoscopy with as equivalent efficacy as universal biennial screening equivalent efficacy as universal biennial screening. Design, Setting, and Participants A retrospective cohort study for developing f-Hb-guided precision interscreening interval was conducted using data on a Taiwanese biennial nationwide FIT screening program that enrolled more than 3 million participants aged 50 to 74 years between 2004 and 2014. The cohort was followed up over time until 2019 to ascertain colorectal neoplasia and causes of death. A comparative study was further designed to compare the use of FIT and colonoscopy between the personalized f-Hb-guided group and the universal biennial screening group given the equivalent efficacy of reducing CRC-related outcomes. Main Outcomes and Measurements A spectrum of f-Hb-guided intervals was determined by using the Poisson regression model given the equivalent efficacy of a universal biennial screening. The use of FIT and colonoscopy for the pragmatic f-Hb-guided interval group was measured compared with the universal biennial screening group. Data analysis was performed from September 2022 to October 2023. Results Using data from the 3 500 250 participants (mean [SD] age, 57.8 [6.0] years) enrolled in the Taiwanese biennial nationwide FIT screening program, an incremental increase in baseline f-Hb associated with colorectal neoplasia and CRC mortality consistently was observed. Participants with different f-Hb levels were classified into distinct risk categories. Various screening intervals by different f-Hb levels were recommended. Using the proposed f-Hb-guided screening intervals, it was found that the personalized method was imputed to reduce the number of FIT tests and colonoscopies by 49% and 28%, respectively, compared with the universal biennial screening. Conclusion and Relevance The gradient relationship between f-Hb and colorectal neoplasia and CRC mortality was used to develop personalized FIT screening with f-Hb-guided screening intervals. Such a precision interscreening interval led to the reduced use of FIT test and colonoscopy without compromising the effectiveness of universal biennial screening.
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Affiliation(s)
- Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Yang Hsu
- Dachung Hospital, Miaoli, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ting-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chiu-Wen Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan
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2
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Rejali L, Nazemalhosseini-Mojarad E, Valle L, Maghsoudloo M, Asadzadeh Aghdaei H, Mohammadpoor H, Zali MR, Khanabadi B, Entezari M, Hushmandi K, Taheriazam A, Hashemi M. Identification of antisense and sense RNAs of intracrine fibroblast growth factor components as novel biomarkers in colorectal cancer and in silico studies for drug and nanodrug repurposing. ENVIRONMENTAL RESEARCH 2023; 239:117117. [PMID: 37805185 DOI: 10.1016/j.envres.2023.117117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/29/2023] [Accepted: 09/09/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is one of the most malignant tumors and in which various efforts for screening is inconclusive.The intracrine FGF panel, the non-tyrosine kinase receptors (NTKR) FGFs and affiliated antisenses play a pivotal role in FGF signaling.The expression levels of coding and non-coding intracrine FGFs were assessed in CRC donors.Also, substantial costs and slow pace of drug discovery give high attraction to repurpose of previously discovered drugs to new opportunities. OBJECTIVES The aim of present study was to evaluate the potential role of the coding and non-coding intracrine FGFs as a new biomarkers for CRC cases and defining drug repurposing to alleviate FGF down regulation. METHODS RNA-seq data of colon adenocarcinomas (COAD) was downloaded using TCGA biolinks package in R.The DrugBank database (https://go.drugbank.com/) was used to extract interactions between drugs and candidate genes. A total of 200 CRC patients with detailed criteria were enrolled.RNAs were extracted with TRIzol-based protocol and amplified via LightCycler® instrument.FGF11 and FGF13 proteins validation was performed by used of immunohistochemistry technique in tumor and non-tumoral samples.Pearson's correlation analysis and ROC curve plotted by Prism 8.0 software. RESULTS RNA-seq data from TCGA was analyzed by normalizing with edgeR.Differentially expressed gene (DEG) analysis was generated. WCC algorithm extracted the most significant genes with a total of 47 genes. Expression elevation of iFGF antisenses (12AS,13As,14AS) compared with the normal colon tissue were observed (P = 0.0003,P = 0.042,P = 0.026, respectively). Moreover,a significant decrease in expression of the corresponding sense iFGF genes was detected (P < 0.0001).Plotted receiver operating characteristic (ROC) curves for iFGF components' expression showed an area of over 0.70 (FGF11-13: 0.71% and FGF12-14: 0.78%, P < 0.001) for sense mRNA expression, with the highest sensitivity for FGF12 (92.8%) and lowest for FGF11 (61.41%).The artificial intelligence (AI) revealed the valproic acid as a repurposing drug to relief the down regulation of FGF12 and 13 in CRC patients. CONCLUSION Intracrine FGFs panel was down regulated versus up regulation of dependent antisenses. Thus, developing novel biomarkers based on iFGF can be considered as a promising strategy for CRC screening.In advanced, valporic acid detected by AI as a repurposing drug which may be applied in clinical trials for CRC treatment.
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Affiliation(s)
- Leili Rejali
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Nazemalhosseini-Mojarad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Laura Valle
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Mazaher Maghsoudloo
- Laboratory of Systems Biology and Bioinformatics, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran; Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadis Mohammadpoor
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Binazir Khanabadi
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maliheh Entezari
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Farhikhtegan Medical Convergence Sciences Research Centre, Farhikhtegan Hospital, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran
| | - Kiavash Hushmandi
- Department of Epidemiology, Faculty Of Veterinary Medicine, University Of Tehran, Tehran, Iran.
| | - Afshin Taheriazam
- Farhikhtegan Medical Convergence Sciences Research Centre, Farhikhtegan Hospital, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran; Department of Orthopedics, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Mehrdad Hashemi
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Farhikhtegan Medical Convergence Sciences Research Centre, Farhikhtegan Hospital, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran.
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3
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Fraser CG. Faecal haemoglobin: Measurement, applications, and future potential. Best Pract Res Clin Gastroenterol 2023; 66:101833. [PMID: 37852705 DOI: 10.1016/j.bpg.2023.101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 10/20/2023]
Abstract
Faecal hemoglobin concentrations (f-Hb) can be quantitated using faecal immunochemical test for haemoglobin (FIT) analytical systems. FIT are of proven value and widely used in colorectal cancer (CRC) screening. Several factors affect f-Hb including sex, age, deprivation, geographical region, and FIT system. Thus, FIT data may not be transferable. Women are disadvantaged in programmes using a single f-Hb threshold for all participants, but risk scoring or sex stratified thresholds could be used to minimise this problem. In addition, low but detectable f-Hb, below the threshold, implies future risk of CRC. In several countries, where colonoscopy resources are constrained, FIT are now accepted as of added value in assessment of patients presenting in primary or secondary care with symptoms, although some serious colorectal disease is missed. Elevated f-Hb in the absence of any discernible colorectal lesions is common and has been found in several diseases with a systemic inflammatory component, including circulatory, respiratory, digestive, neuropsychological, blood and endocrine diseases, and others. There is growing evidence for the value of f-Hb in post-polypectomy surveillance, potentially saving costs and colonoscopy. There may be a role for FIT systems which have lower limits of detection than currently available methods. The faecal material remaining in FIT specimen collection devices could be used for further studies, including assessment of the microbiome. The estimation of f-Hb is now a mature investigative tool but further research will undoubtedly expand applications of value.
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Affiliation(s)
- Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee School of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
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4
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Kortlever TL, van der Vlugt M, Duijkers FAM, Masclee A, Kraaijenhagen R, Spaander MCW, Lansdorp-Vogelaar I, Bossuyt PM, Dekker E. Diagnostic yield of a risk model versus faecal immunochemical test only: a randomised controlled trial in a colorectal cancer screening programme. Br J Cancer 2023; 129:791-796. [PMID: 37468570 PMCID: PMC10449911 DOI: 10.1038/s41416-023-02358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Combining the faecal immunochemical test (FIT) result with risk factors for advanced neoplasia (AN) may increase the yield of colorectal cancer (CRC) screening without increasing the number of colonoscopies. We conducted a randomised controlled trial in the Dutch CRC screening programme to evaluate a previously developed risk model including FIT, age, sex, smoking status, and CRC family history. METHODS A total of 22,748 individuals aged 56-75 years were pre-randomised to the risk-model group or the FIT-only group. Both groups received the FIT; those allocated to the risk-model group also received a single-page questionnaire. Study participants with a positive result (FIT ≥ 15 µg Hb/g faeces and/or risk ≥0.10) were referred for colonoscopy. The primary outcome measure was the proportion of invitees in whom AN was detected. RESULTS In the risk-model group, 3113/11,364 invitees (27%) returned the FIT and questionnaire versus 3061/11,384 invitees (27%) in the FIT-only group (p = 0.40). The yield of AN was 3.70/1000 invitees in the risk-model group versus 3.43/1000 in the FIT-only group (absolute difference: 0.27/1000, 95%CI: -1.30 to 1.82, p = 0.82). CONCLUSIONS Combining FIT with risk factors for CRC did not increase the yield of AN compared to FIT-only in an existing CRC screening programme. There was no difference in participation between groups. CLINICAL TRIAL REGISTRATION NCT04490551 (ClinicalTrials.gov).
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Affiliation(s)
- Tim L Kortlever
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Bergman Clinics, location IZA, Amsterdam, The Netherlands
| | - Floor A M Duijkers
- Department of Human Genetics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Ad Masclee
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Roderik Kraaijenhagen
- Netherlands Institute for Prevention and E-health Development (NIPED), Amsterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
- Bergman Clinics, location IZA, Amsterdam, The Netherlands.
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5
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Winter JM, Cornthwaite KJ, Young GP, Wilson C, Chen G, Woodman R, Coats M, Fraser R, Cock C, Bampton P, Symonds EL. FIT for purpose: study protocol for a randomized controlled trial to personalize surveillance colonoscopy for individuals at elevated risk of colorectal cancer. Int J Colorectal Dis 2023; 38:201. [PMID: 37490150 PMCID: PMC10368549 DOI: 10.1007/s00384-023-04493-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE There is increasing demand for colorectal cancer (CRC) surveillance, but healthcare capacity is limited. The burden on colonoscopy resources could be reduced by personalizing surveillance frequency using the fecal immunochemical test (FIT). This study will determine the safety, cost-effectiveness, and patient acceptance of using FIT to extend surveillance colonoscopy intervals for individuals at elevated risk of CRC. METHODS This multicenter, prospective, randomized controlled trial will invite participants who are scheduled for surveillance colonoscopy (due to a personal history of adenomas or a family history of CRC) and who have returned a low fecal hemoglobin (< 2 μg Hb/g feces; F-Hb) using a two-sample FIT (OC Sensor, Eiken Chemical Company) in the prior 3 years. A total of 1344 individuals will be randomized to either surveillance colonoscopy as scheduled or delayed by 1 or 2 years for individuals originally recommended a 3- or 5-year surveillance interval, respectively. The primary endpoint is incidence of advanced neoplasia (advanced adenoma and/or CRC). Secondary endpoints include cost-effectiveness and consumer acceptability of extending surveillance intervals, determined using surveys and discrete choice experiments. CONCLUSION This study will establish the safety, cost-effectiveness, and acceptability of utilizing a low FIT Hb result to extend colonoscopy surveillance intervals in a cohort at elevated risk for CRC. This personalized approach to CRC surveillance will lead to a reduction in unnecessary colonoscopies, increases in healthcare savings, and a better patient experience. TRIAL REGISTRATION: Registration was approved on December 9, 2019 with the Australian New Zealand Clinical Trials Registry ANZCTR 12619001743156.
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Affiliation(s)
- Jean M Winter
- Cancer Research, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
| | - Kathryn J Cornthwaite
- Cancer Research, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Graeme P Young
- Cancer Research, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Carlene Wilson
- Cancer Research, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caulfield East, VIC, Australia
| | - Richard Woodman
- Cancer Research, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Michelle Coats
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Robert Fraser
- Cancer Research, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Charles Cock
- Cancer Research, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Peter Bampton
- Cancer Research, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Erin L Symonds
- Cancer Research, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Bedford Park, SA, Australia
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6
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Ayling RM, Machesney M. Faecal immunochemical testing (FIT) in primary care: a follow-up service evaluation. J Clin Pathol 2023:jcp-2022-208459. [PMID: 37072172 DOI: 10.1136/jcp-2022-208459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 03/22/2023] [Indexed: 04/20/2023]
Abstract
AIM Colorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute for Health and Care Excellence guidance for faecal immunochemical testing (FIT), we introduced a service for the measurement of faecal haemoglobin (f-Hb) in symptomatic patients. Previously, we evaluated the first 6 months of the service in three local boroughs, here we re-examine the use of FIT, over a similar 6 months in the two successive years. METHODS Patients who had FIT requested in April-September 2020 and 2021 were studied. Results were obtained from the laboratory information systems and matched with the clinical outcomes of those referred via the urgent lower gastrointestinal cancer pathway. Patient demographics, reason for referral, clinical outcome and diagnostic test performance are reported. RESULTS In 2020, 4042 samples were analysed and 57 CRC detected. In 2021, 10 508 samples were analysed and 65 CRC detected. Six (4.9%) patients with CRC had f-Hb <10 µg/g, of whom three were anaemic. In 2020, 27.7% of samples were from patients under 50 years; and in 2021, 32.8%. Sensitivity, specificity, positive predictive value and negative predictive value of f-Hb at ≥10 µg/g for CRC were 92.9%, 46.6%, 6.4% and 99.4% in 2020 and 96.9%, 29.9%, 3.2% and 99.8% in 2021. CONCLUSIONS As currently used in primary care in North East London, specificity of FIT at a cut-off of 10 µg/g is much lower than in published studies and the impact of this on colorectal services needs to be considered.
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Affiliation(s)
- Ruth M Ayling
- Clinical Biochemistry, Barts Health NHS Trust, London, UK
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7
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Breekveldt ECH, Toes-Zoutendijk E, van de Schootbrugge-Vandermeer HJ, de Jonge L, Kooyker AI, Spaander MCW, van Vuuren AJ, van Kemenade FJ, Ramakers C, Dekker E, Nagtegaal ID, van Leerdam ME, Lansdorp-Vogelaar I. Factors associated with interval colorectal cancer after negative FIT: Results of two screening rounds in the Dutch FIT-based CRC screening program. Int J Cancer 2023; 152:1536-1546. [PMID: 36444504 PMCID: PMC10107864 DOI: 10.1002/ijc.34373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
The interval colorectal cancer (CRC) rate after negative fecal immunochemical testing (FIT) is an important quality indicator of CRC screening programs. We analyzed the outcomes of two rounds of the FIT-based CRC screening program in the Netherlands, using data from individuals who participated in FIT-screening from 2014 to 2017. Data of individuals with one prior negative FIT (first round) or two prior negative FITs (first and second round) were included. Outcomes included the incidence of interval CRC in FIT-negative participants (<47 μg Hb/g feces [μg/g]), FIT-sensitivity, and the probability of detecting an interval CRC by fecal hemoglobin concentration (f-Hb). FIT-sensitivity was estimated using the detection method and the proportional incidence method (based on expected CRC incidence). Logistic regression analysis was performed to estimate whether f-Hb affects probability of detecting interval CRC, adjusted for sex- and age-differences. Incidence of interval CRC was 10.4 per 10 000 participants after the first and 9.6 after the second screening round. FIT-sensitivity based on the detection method was 84.4% (95%CI 83.8-85.0) in the first and 73.5% (95% CI 71.8-75.2) in the second screening round. The proportional incidence method resulted in a FIT-sensitivity of 76.4% (95%CI 73.3-79.6) in the first and 79.1% (95%CI 73.7-85.3) in the second screening round. After one negative FIT, participants with f-Hb just below the cut-off (>40-46.9 μg/g) had a higher probability of detecting an interval CRC (OR 16.9; 95%CI: 14.0-20.4) than had participants with unmeasurable f-Hb (0-2.6 μg/g). After two screening rounds, the odds ratio for interval CRC was 12.0 (95%CI: 7.8-17.6) for participants with f-Hb just below the cut-off compared with participants with unmeasurable f-Hb. After both screening rounds, the Dutch CRC screening program had a low incidence of interval CRC and an associated high FIT-sensitivity. Our findings suggest there is a potential for further optimizing CRC screening programs with the use of risk-stratified CRC screening based on prior f-Hb.
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Affiliation(s)
- Emilie C H Breekveldt
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Lucie de Jonge
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Arthur I Kooyker
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers-Academic Medical Center, Amsterdam, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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8
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Ribe SG, Botteri E, Løberg M, Randel KR, Kalager M, Nilsen JA, Gulichsen EH, Holme Ø. Impact of time between faecal immunochemical tests in colorectal cancer screening on screening results: A natural experiment. Int J Cancer 2023; 152:1414-1424. [PMID: 36346118 PMCID: PMC10098820 DOI: 10.1002/ijc.34351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
Repeated rounds of faecal immunochemical testing (FIT) for occult blood is a common method for screening for colorectal cancer (CRC). However, the time interval between FIT rounds is not thoroughly investigated. In a CRC screening trial in South-Eastern Norway, individuals were invited for biennial FIT between 2012 and 2019. The positivity threshold was >15 mcg haemoglobin/g faeces (mcg/g). Due to organizational challenges, the interval between screening rounds randomly varied between 1.5 and 3.5 years, forming a natural experiment. We investigated the detection rate of CRC and advanced neoplasia (AN: CRC or advanced adenoma) at the subsequent round (FIT2 ), according to the faecal haemoglobin concentration (f-Hb) at the initial screening round (FIT1 ), and time between the two screening rounds. 18 522 individuals with negative FIT1 who attended FIT2 were included in this study. 245 AN were detected at FIT2 , of which 34 were CRC. The CRC detection rate at FIT2 for participants with FIT1 = 0 mcg/g was 0.09% while it was 0.28% for participant with 0 > FIT1 ≤ 15 mcg/g; odds ratio (OR) 3.22, 95% CI 1.49-6.95. For each 3 months' increment between FITs, the OR for detecting CRC was 1.33 (95% CI 0.98-1.79), while the OR was 1.13 (1.02-1.26) for AN. Individuals with FIT1 -value of 0 mcg/g, had a lower AN detection rate compared with participants with 0 > FIT1 ≤ 15 mcg/g, irrespective of time between tests. Although CRC and AN detection rates increase with increasing time interval between FITs, individuals with undetectable f-Hb at first screen have substantially lower risk of CRC at the next screening round compared with individuals with detectable f-Hb.
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Affiliation(s)
- Sara G Ribe
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Center for Cancer Treatment, Sørlandet Hospital, Kristiansand, Norway.,Clinical Effectiveness Research Group, Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Clinical Effectiveness Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magnus Løberg
- Clinical Effectiveness Research Group, Institute for Health and Society, University of Oslo, Oslo, Norway.,Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Kristin R Randel
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Mette Kalager
- Clinical Effectiveness Research Group, Institute for Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | - Øyvind Holme
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Clinical Effectiveness Research Group, Institute for Health and Society, University of Oslo, Oslo, Norway.,Department of Medicine, Sørlandet Hospital, Kristiansand, Norway
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9
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Heisser T, Cardoso R, Niedermaier T, Hoffmeister M, Brenner H. Making colonoscopy-based screening more efficient: A "gateopener" approach. Int J Cancer 2023; 152:952-961. [PMID: 36214791 DOI: 10.1002/ijc.34317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 01/06/2023]
Abstract
Screening colonoscopy for early detection and prevention of colorectal cancer (CRC) is mostly used inefficiently. Here, we assessed the potential of an innovative approach to colonoscopy-based screening, by use of a single, low threshold fecal immunochemical test (FIT) as a "gateopener" for screening colonoscopy. Using COSIMO, a validated simulation model, we modeled scenarios including either direct invitation to screening colonoscopy or an alternative approach involving mailing a single ("gateopener") FIT along with an invitation to colonoscopy contingent on a FIT value above a low threshold yielding a 50% positivity rate (ie, every other pretest will be positive). Under plausible assumptions on screening offer adherence, we found that such "gateopener screening" (use of screening colonoscopy contingent on a positive, low threshold gateopener FIT) approximately doubled cancer detection rates vs conventional screening. In those spared from screening colonoscopy due to a negative gateopener FIT pretest, numbers needed to screen were 10-times higher vs those for individuals with a positive FIT, peaking in >2000 and >3800 (hypothetically) needed colonoscopies to detect one case of cancer in men and women, respectively. Gateopener screening resulted in 42%-51% and 59%-65% more prevented CRC cases and deaths, respectively. In summary, by directing colonoscopy capacities to those most likely to benefit, offering screening colonoscopy contingent on a "gateopener" low-threshold FIT would substantially enhance efficiency of colonoscopy screening.
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Affiliation(s)
- Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Rafael Cardoso
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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10
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Breekveldt ECH, Toes-Zoutendijk E, de Jonge L, Spaander MCW, Dekker E, van Kemenade FJ, van Vuuren AJ, Ramakers CRB, Nagtegaal ID, van Leerdam ME, Lansdorp-Vogelaar I. Personalized colorectal cancer screening: study protocol of a mixed-methods study on the effectiveness of tailored intervals based on prior f-Hb concentration in a fit-based colorectal cancer screening program (PERFECT-FIT). BMC Gastroenterol 2023; 23:45. [PMID: 36814185 PMCID: PMC9948315 DOI: 10.1186/s12876-023-02670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND In 2014, the national population-based colorectal cancer (CRC) screening program was implemented in the Netherlands. Biennial fecal immunochemical testing (FIT) for hemoglobin (Hb) is used at a cut-off of 47 µg Hb per gram feces. The CRC screening program successfully started, with high participation rates and yield of screening. Now that the program has reached a steady state, there is potential to further optimize the program. Previous studies showed that prior fecal Hb (f-Hb) concentrations just below the FIT cut-off are associated with a higher risk for detection of advanced neoplasia (AN) at subsequent screening rounds. We aim to achieve a better balance between the harms and benefits of CRC screening by offering participants tailored invitation intervals based on prior f-Hb concentrations after negative FIT. METHODS This mixed-methods study will be performed within the Dutch national CRC screening program and will consist of: (1) a randomized controlled trial (RCT), (2) focus group studies, and (3) decision modelling. The primary outcome is the yield of AN per screened individual in personalized screening vs. uniform screening. Secondary outcomes are perspectives on, acceptability of and adherence to personalized screening, as well as long-term outcomes of personalized vs. uniform screening. The RCT will include 20,000 participants of the Dutch CRC screening program; 10,000 in the intervention and 10,000 in the control arm. The intervention arm will receive a personalized screening interval based on the prior f-Hb concentration (1, 2 or 3 years). The control arm will receive a screening interval according to current practice (2 years). The focus group studies are designed to understand individuals' perspectives on and acceptability of personalized CRC screening. Results of the RCT will be incorporated into the MISCAN-Colon model to determine long-term benefits, harms, and costs of personalized vs. uniform CRC screening. DISCUSSION The aim of this study is to evaluate the yield, feasibility, acceptability and (cost-) effectiveness of personalized CRC screening through tailored invitation intervals based on prior f-Hb concentrations. This knowledge may be of guidance for health policy makers and may provide evidence for implementing personalized CRC screening in The Netherlands and/or other countries using FIT as screening modality. TRIAL REGISTRATION ClinicalTrials.gov, NCT05423886, June 21, 2022, https://clinicaltrials.gov/ct2/show/NCT05423886.
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Affiliation(s)
- Emilie C. H. Breekveldt
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC University Medical Center, Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, The Netherlands ,grid.430814.a0000 0001 0674 1393Department of Gastroenterology and Hepatology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Esther Toes-Zoutendijk
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC University Medical Center, Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Lucie de Jonge
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC University Medical Center, Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, The Netherlands
| | - Manon C. W. Spaander
- grid.5645.2000000040459992XDepartment of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Evelien Dekker
- grid.7177.60000000084992262Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre – Location AMC, Amsterdam, The Netherlands
| | - Folkert J. van Kemenade
- grid.5645.2000000040459992XDepartment of Pathology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Anneke J. van Vuuren
- grid.5645.2000000040459992XDepartment of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Christian R. B. Ramakers
- grid.5645.2000000040459992XDepartment of Clinical Chemistry, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Iris D. Nagtegaal
- grid.10417.330000 0004 0444 9382Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Monique E. van Leerdam
- grid.430814.a0000 0001 0674 1393Department of Gastroenterology and Hepatology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands ,grid.10419.3d0000000089452978Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Iris Lansdorp-Vogelaar
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC University Medical Center, Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, The Netherlands
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11
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Meester RGS, van de Schootbrugge-Vandermeer HJ, Breekveldt ECH, de Jonge L, Toes-Zoutendijk E, Kooyker A, Nieboer D, Ramakers CR, Spaander MCW, van Vuuren AJ, Kuipers EJ, van Kemenade FJ, Nagtegaal ID, Dekker E, van Leerdam ME, Lansdorp-Vogelaar I. Faecal occult blood loss accurately predicts future detection of colorectal cancer. A prognostic model. Gut 2023; 72:101-108. [PMID: 35537811 PMCID: PMC9763180 DOI: 10.1136/gutjnl-2022-327188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/16/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine the prognostic potential of repeated faecal haemoglobin (F-Hb) concentration measurements in faecal immunochemical test (FIT)-based screening for colorectal cancer (CRC). DESIGN Prognostic model. SETTING Dutch biennial FIT-based screening programme during 2014-2018. PARTICIPANTS 265 881 participants completing three rounds of FIT, with negative test results (F-Hb <47 µg Hb/g faeces) in rounds 1 and 2. INTERVENTIONS Colonoscopy follow-up in participants with a positive FIT (F-Hb ≥47 µg Hb/g faeces). MAIN OUTCOMES We evaluated prognostic models for detecting advanced neoplasia (AN) and CRC in round 3, with as predictors, participant age, sex, F-Hb in rounds 1 and 2, and categories/combinations/non-linear transformations of F-Hb. Primary evaluation criteria included: risk prediction accuracy (calibration), discrimination of participants with versus without AN or CRC (optimism-adjusted C-statistics, range 0.5-1.0), the degree of risk stratification and C-statistics in external validation. RESULTS Among study participants, 8806 (3.3%) had a positive FIT result, 3254 (1.2%) had AN detected and 557 (0.2%) had cancer. F-Hb concentrations in rounds 1 and 2 were the strongest outcome predictors, with adjusted ORs of up to 9.4 (95% CI 7.5 to 11.7) for the highest F-Hb category. Risk predictions matched the observed risk for most participants (calibration intercept -0.008 to -0.099; slope 0.982-0.998), and discriminated participants with versus without AN or CRC with C-statistics of 0.78 (95% CI 0.77 to 0.79) and 0.73 (95% CI 0.71 to 0.75), respectively. The predicted risk ranged from 0.4% to 36.7% for AN and from 0.0% to 5.5% for CRC across participants. In external validation, the model retained similar discrimination accuracy for AN (C-statistic 0.77, 95% CI 0.66 to 0.87) and CRC (C-statistic 0.78, 95% CI 0.66 to 0.91). CONCLUSION Participants at lower versus higher risk of future AN or CRC can be accurately identified based on their age, sex and particularly, prior F-Hb concentrations. Risk stratification should be considered based on this information.
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Affiliation(s)
- Reinier G S Meester
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | | | - Emilie C H Breekveldt
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Lucie de Jonge
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Arthur Kooyker
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Christian R Ramakers
- Clinical Chemistry, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | | | - Iris D Nagtegaal
- Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Monique E van Leerdam
- Gastroenterology and Hepatology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands,Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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12
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Clark GR, Fraser CG, Strachan JA, Steele RJ. Comparison with first round findings of faecal haemoglobin concentrations and clinical outcomes in the second round of a biennial faecal immunochemical test based colorectal cancer screening programme. J Med Screen 2022; 29:249-254. [PMID: 35747907 PMCID: PMC9574424 DOI: 10.1177/09691413221110012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective How faecal haemoglobin concentrations (f-Hb) vary from one round to the next
in a colorectal cancer (CRC) screening programme, and relate to colonoscopy
findings, are unknown. Our aim was to use data from the first two rounds of
the faecal immunochemical test (FIT) based Scottish Bowel Screening
Programme (SBoSP) to explore these issues. Methods Faecal haemoglobin concentration (f-Hb) percentiles in the second round were
compared with those in the first when the first round yielded a negative FIT
result (<80 µg Hb/g faeces), a positive FIT but no colonoscopy, CRC, all
adenoma, and a negative colonoscopy. In addition, the outcomes in the first
and second rounds were compared. Results The profiles of f-Hb in the first and second rounds differed in (a) those who
had had a negative FIT result in the first round and (b) those in whom
neoplastic pathology had been found. In contrast, the pattern of difference
between profiles in those who had had a negative colonoscopy was very
similar to that in those in whom an adenoma had been found. In addition, the
risk of CRC being diagnosed in the second round after a negative colonoscopy
in the first was 3.0%, not very different to that after a negative test
result (4.9%). Conclusions Adenomas may be rarely the cause of a positive FIT result. An alternative
explanation as to why these are detected using FIT is required. In addition,
a negative colonoscopy for a positive FIT result does not rule out the
finding of significant neoplastic pathology in the next round.
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Affiliation(s)
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, UK
| | - Judith A Strachan
- Blood Sciences and Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, UK
| | - Robert Jc Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, UK
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13
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Hunt N, Rao C, Logan R, Chandrabalan V, Oakey J, Ainsworth C, Smith N, Banerjee S, Myers M. A cohort study of duplicate faecal immunochemical testing in patients at risk of colorectal cancer from North-West England. BMJ Open 2022; 12:e059940. [PMID: 35418441 PMCID: PMC9014104 DOI: 10.1136/bmjopen-2021-059940] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES We sought to investigate if duplicate faecal immunochemical testing (FIT) sampling improves the negative and positive predictive value of patients thought to be at risk of colorectal cancer (CRC). Specifically, we aimed to investigate whether the proportion of FIT-negative CRC missed by a single FIT test in symptomatic patients could be reduced by duplicate FIT testing. DESIGN A retrospective service evaluation cohort study of the diagnostic accuracy of duplicate FIT testing. SETTING Patients referred from primary care with suspected CRC to four secondary care trusts in North-West England. PARTICIPANTS 28 622 patients over 18-years-old with lower gastrointestinal symptoms suggestive of CRC who completed two FIT samples. PRIMARY AND SECONDARY OUTCOME MEASURES The performance of duplicate FIT for detecting CRC at a threshold of 10 µgHb/g. RESULTS The sensitivity if either test was >10 µgHb/g was 0.978 (0.955-0.989), specificity was 0.662 (0.657-0.668), positive predictive value 0.031 (0.028-0.035) and negative predictive value 1.00 (0.999-1.00). Despite two-thirds of patients (18952) being negative following two tests, at this threshold only seven CRC were missed over a 26-month period. All seven patients had other high-risk features which should have prompted investigation. CONCLUSIONS This study suggests that in routine NHS practice, a duplicate FIT sample strategy together with clinical evaluation for evidence of anaemia and weight loss is superior to a single FIT sample alone and would allow symptomatic patients to be managed in primary care without the need for urgent referral to secondary care for urgent colonic imaging.
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Affiliation(s)
- Natalie Hunt
- Department of Clinical Biochemistry, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Christopher Rao
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Robert Logan
- Department of Gastroenterology, King's College London, London, UK
| | - Vishnu Chandrabalan
- Department of Colorectal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Jane Oakey
- Clinical Biochemistry, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | | | - Neil Smith
- NHS Blackburn with Darwen CCG, Blackburn, UK
| | | | - Martin Myers
- Department of Clinical Biochemistry, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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14
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van Duuren LA, Ozik J, Spliet R, Collier NT, Lansdorp-Vogelaar I, Meester RGS. An Evolutionary Algorithm to Personalize Stool-Based Colorectal Cancer Screening. Front Physiol 2022; 12:718276. [PMID: 35153804 PMCID: PMC8826712 DOI: 10.3389/fphys.2021.718276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/21/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fecal immunochemical testing (FIT) is an established method for colorectal cancer (CRC) screening. Measured FIT-concentrations are associated with both present and future risk of CRC, and may be used for personalized screening. However, evaluation of personalized screening is computationally challenging. In this study, a broadly applicable algorithm is presented to efficiently optimize personalized screening policies that prescribe screening intervals and FIT-cutoffs, based on age and FIT-history. METHODS We present a mathematical framework for personalized screening policies and a bi-objective evolutionary algorithm that identifies policies with minimal costs and maximal health benefits. The algorithm is combined with an established microsimulation model (MISCAN-Colon), to accurately estimate the costs and benefits of generated policies, without restrictive Markov assumptions. The performance of the algorithm is demonstrated in three experiments. RESULTS In Experiment 1, a relatively small benchmark problem, the optimal policies were known. The algorithm approached the maximum feasible benefits with a relative difference of 0.007%. Experiment 2 optimized both intervals and cutoffs, Experiment 3 optimized cutoffs only. Optimal policies in both experiments are unknown. Compared to policies recently evaluated for the USPSTF, personalized screening increased health benefits up to 14 and 4.3%, for Experiments 2 and 3, respectively, without adding costs. Generated policies have several features concordant with current screening recommendations. DISCUSSION The method presented in this paper is flexible and capable of optimizing personalized screening policies evaluated with computationally-intensive but established simulation models. It can be used to inform screening policies for CRC or other diseases. For CRC, more debate is needed on what features a policy needs to exhibit to make it suitable for implementation in practice.
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Affiliation(s)
- Luuk A. van Duuren
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jonathan Ozik
- Decision and Infrastructure Sciences, Argonne National Laboratory, Lemont, IL, United States
| | - Remy Spliet
- Econometric Institute, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Nicholson T. Collier
- Decision and Infrastructure Sciences, Argonne National Laboratory, Lemont, IL, United States
| | | | - Reinier G. S. Meester
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
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15
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Faecal Haemoglobin Estimated by Faecal Immunochemical Tests-An Indicator of Systemic Inflammation with Real Clinical Potential. Diagnostics (Basel) 2021; 11:diagnostics11112093. [PMID: 34829442 PMCID: PMC8622944 DOI: 10.3390/diagnostics11112093] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/21/2022] Open
Abstract
Multimorbidity is the major cause of ill-health and premature death in developed countries. The ability to identify individuals at risk of developing chronic disease, particularly multimorbidity, reliably, and simply, and to identify undiagnosed disorders, is vital to reducing the global burden of disease. This narrative review, the first of recent studies, demonstrates that raised faecal haemoglobin concentration (f-Hb) is associated with increased all-cause and cause-specific mortality and with longer-term conditions including diabetes, hypertension, cardiovascular disease, and psoriasis, and with probable intake of particulate matter. We and others have hypothesized that elevated f-Hb (measured using a faecal immunochemical test) has considerable potential to identify individuals at risk of, or who already have, early stage, undiagnosed chronic disease. If f-Hb does prove to be an effective biomarker for chronic disease and multimorbidity, individuals with detectable f-Hb, but without an obvious source of gastrointestinal blood loss, could benefit from further assessment and early intervention. To test this hypothesis rigorously, longitudinal data-linkage methodology is required linking colorectal cancer screening data, and data on patients presenting with lower gastrointestinal symptoms, with routinely collected health information.
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16
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Lansdorp-Vogelaar I, Meester R, de Jonge L, Buron A, Haug U, Senore C. Risk-stratified strategies in population screening for colorectal cancer. Int J Cancer 2021; 150:397-405. [PMID: 34460107 PMCID: PMC9293115 DOI: 10.1002/ijc.33784] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022]
Abstract
Colorectal cancer (CRC) screening has been demonstrated to reduce CRC incidence and mortality. However, besides such benefits, CRC screening is also associated with potential harmful effects. In an ideal world, screening would only be directed to the small proportion of the population that might potentially benefit. Risk‐based screening can be seen as a first step towards this ideal world, by redistributing screening resources from low‐risk to high‐risk individuals. In theory, this should result in scarce resources being used in individuals who benefit most, while intensity of screening is reduced in individuals who benefit less, hence improving the benefit‐harm ratio among all invitees. Available strategies that have been proposed for risk‐based CRC screening include using information on age, sex, prior screening history, lifestyle and/or genetic information. Implementation of risk‐based screening requires careful consideration of reliable risk prediction models, participation with screening and informed decision‐making. While it is important to recognise the limitations of current approaches, available evidence suggests that it might be feasible to start planning the introduction of tailored strategies within screening programmes. Implementing risk‐based screening based on age, sex and prior screening history alone would already represent a substantial improvement over current uniform screening approaches. We propose that it is time that screening programmes start there and continue striving towards more comprehensive approaches embedding primary prevention as an effective approach to lower risk for everyone.
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Affiliation(s)
- Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Reinier Meester
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Lucie de Jonge
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Andrea Buron
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Carlo Senore
- SSD Epidemiologia e Screening - CPO, University Hospital Cittàdella Salute e dellaScienza, Turin, Italy
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17
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Balamou C, Koïvogui A, Rodrigue CM, Clerc A, Piccotti C, Deloraine A, Exbrayat C. Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program. World J Gastroenterol 2021; 27:5272-5287. [PMID: 34497450 PMCID: PMC8384754 DOI: 10.3748/wjg.v27.i31.5272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/03/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The rate of positive tests using fecal immunochemical test (FIT) does not decrease with subsequent campaigns, but the positive predictive value of advanced neoplasia significantly decreases in subsequent campaign after a first negative test. A relationship between the fecal hemoglobin concentration (Fhb) and the opportunity to detect a colorectal cancer in subsequent campaign has been shown.
AIM To predict the severity of colorectal lesions based on Fhb measured during previous colorectal cancer screening campaign.
METHODS This etiological study included 293750 patients aged 50-74, living in Auvergne-Rhône-Alpes (France). These patients completed at least two FIT [test(-1) and test(0)] between June 2015 and December 2019. Delay between test(-1) and test(0) was > 1 year and test(-1) result was negative (< 150 ngHb/mL). The severity of colorectal lesions diagnosed at test(0) was described according to Fhb measured at test(-1) [Fhb(-1)]. The relationship between the severity classified in seven ordinal categories and the predictive factors was analyzed in an ordered multivariate polytomous regression model.
RESULTS The test(0) positive rate was 4.0%, and the colonoscopy completion rate was 97.1% in 11594 patients who showed a positive test(0). The colonoscopy detection rate was 77.7% in those 11254 patients who underwent a colonoscopy. A total of 8748 colorectal lesions were detected (including 2182 low-risk-polyps, 2400 high-risk-polyp, and 502 colorectal cancer). The colonoscopy detection rate varied significantly with Fhb(-1) [0 ngHb/mL: 75.6%, (0-50 ngHb/mL): 77.3%, (50-100 ngHb/mL): 88.7%, (100-150 ngHb/mL): 90.3%; P = 0.001]. People with a Fhb(-1) within (100-150 ngHb/mL) (P = 0.001) were 2.6 (2.2; 3.0) times more likely to have a high severity level compared to those having a Fhb(-1) value of zero. This risk was reduced by 20% in patients aged 55-59 compared to those aged < 55 [adjusted odds ratio: 0.8 (0.6; 1.0)].
CONCLUSION The study showed that higher Fhb(-1) is correlated to an increased risk of severity of colorectal lesions. This risk of severity increased among first-time participants (age < 55) and the elderly (≥ 70). To avoid the loss of chance in these age groups, the FIT positivity threshold should be reduced to 100 ngHb/mL. The other alternative would be to reduce the time between the two tests in these age groups from the current 2 years to 1 year.
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Affiliation(s)
- Christian Balamou
- Site de l'Ain, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Bourg-en-Bresse 01000, France
| | - Akoï Koïvogui
- Site de Seine-Saint-Denis, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France, Bondy 93146, France
| | - Christelle M Rodrigue
- Site de l'Ain, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Bourg-en-Bresse 01000, France
| | - Aurélie Clerc
- Sites Savoie & Haute Savoie, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Chambéry 73000, France
| | - Claire Piccotti
- Site de Drôme Ardèche, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Valence 26000, France
| | - Anne Deloraine
- Sites Savoie & Haute Savoie, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Chambéry 73000, France
| | - Catherine Exbrayat
- Site Isère & Drôme-Ardèche, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Meylan 38240, France
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18
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Kortlever TL, van der Vlugt M, Dekker E, Bossuyt PMM. Individualized faecal immunochemical test cut-off based on age and sex in colorectal cancer screening. Prev Med Rep 2021; 23:101447. [PMID: 34168954 PMCID: PMC8209662 DOI: 10.1016/j.pmedr.2021.101447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 12/13/2022] Open
Abstract
The risk of having colorectal cancer (CRC) or its precursors vary with age and sex. Yet, most CRC screening programs using the quantitative faecal immunochemical test (FIT) use a uniform FIT cut-off. We aimed to calculate individualized FIT cut-offs based on age and sex. Data from a study of 1,112 asymptomatic average-risk screening participants undergoing colonoscopy without preselection were used to build a logistic regression model to calculate the risk of having advanced neoplasia (AN) at colonoscopy using age, sex, and FIT concentration as variables. We calculated age- and sex-adjusted FIT cut-off concentrations based on a uniform risk threshold. In a total of 101 of the 1,112 participants AN was detected at colonoscopy. We selected a risk threshold that would produce a specificity of 96.9% in the study group, matching the specificity of FIT at a cut-off of 20 µg Hb/g faeces. At this threshold, age- and sex-adjusted FIT cut-off concentrations ranged from 36.9 µg Hb/g faeces for 50-year-old women to 9.5 µg Hb/g faeces for 75-year old men. At this level of specificity, the risk-based model reached a sensitivity for AN of 28.7% (95%CI: 20.8 to 38.2) versus 27.7% (95%CI: 19.9 to 37.1) for FIT only. Using a risk threshold instead of a uniform FIT-based threshold for inviting screening participants to follow-up colonoscopy ensures that everyone has a comparable risk of AN prior to colonoscopy and may improve the detection of advanced neoplasia, although the absolute magnitude of the increase is likely to be limited.
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Affiliation(s)
- Tim L Kortlever
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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19
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Hultcrantz R. Aspects of colorectal cancer screening, methods, age and gender. J Intern Med 2021; 289:493-507. [PMID: 32929813 PMCID: PMC8048936 DOI: 10.1111/joim.13171] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is, besides breast, prostate, lung and skin cancers, the most common cancer worldwide and is suitable for screening. The incidence of CRC varies considerably in different parts of the world: in well-developed countries, the incidence is between 30 and 70 per 100 000 inhabitants, whereas in less-developed countries such as sub-Saharan Africa, it is 10-20/100 000 inhabitants. Women have a lower incidence of CRC, which is usually one-third of total incidence. Several studies have shown that it is possible to decrease mortality from CRC with about 20%, which is evidenced through the data from countries with screening programmes. Though the method of choice to identify blood samples in faecal matter is under debate, the most feasible way is to perform colonoscopy. Other methods include more advanced faecal analyses, testing for mutations from CRC, sigmoidoscopy, CT colonoscopy or optical colonoscopy. Colonoscopy is in most countries not available in sufficient amount and has to be carried out with great accuracy; otherwise, lesions will be missed to identify, thus leading to complications. Gender is an issue in CRC screening, as women have about 20% fewer colorectal adenomas and CRCs, but they also have more right-sided lesions, which are more difficult to detect with tests for faecal blood since they create less blood in faeces. Thus, other strategies may have to be developed for women in order for screening to have the same effect. It is essential to introduce colorectal cancer screening in all countries together with other clinical pieces of advice such as information on smoking, obesity and exercise in order to reduce one of the most dangerous cancers.
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Affiliation(s)
- R Hultcrantz
- From the, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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20
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Ibuka T, Adachi S, Horibe Y, Ohno T, Mabuchi M, Suzuki Y, Yamauchi O, Takada E, Iwama M, Saito K, Arao M, Takai K, Araki H, Shimizu M. Effects of antithrombotic drugs on the results of fecal immunochemical test in colorectal neoplasms screening. Sci Rep 2021; 11:4348. [PMID: 33623065 PMCID: PMC7902607 DOI: 10.1038/s41598-021-83007-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/22/2021] [Indexed: 12/12/2022] Open
Abstract
Fecal immunochemical test (FIT) is widely used as a colorectal cancer screening tool. Antithrombotic drugs may affect the screening performance of FIT for colorectal tumors. The aim of this study was to clarify the effect of antithrombotic agents on FIT accuracy in screening for colorectal neoplasms. This retrospective study enrolled a total of 758 patients who underwent both FIT and total colonoscopy. The effect of antithrombotic drugs on FIT accuracy in detecting colorectal neoplasms (CN), including colorectal cancer (CRC), advanced adenoma (AA), and non-advanced adenoma (NAA), was examined. Of the 758 patients, 144 (19%) received antithrombotic drugs (administration group). In administration group, 61/144 (42%) cases had CN [CRC:14, AA:15, NAA:32] and 217/614 (35%) cases had CN (CRC:43, AA:56, NAA:118) in non-administration group. The prevalence of CN was not significantly different between the two groups (p = 0.1157). There was no significant difference in sensitivity or specificity of the detection of all types of CN with or without taking antithrombotic drugs. Neither the positive predictive value nor negative predictive value of FIT was affected by antithrombotic drug administration. Taking antithrombotic drugs may not have a large impact on sensitivity, specificity, positive predictive value, or negative predictive value of FIT in screening for CN.
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Affiliation(s)
- Takashi Ibuka
- Division for Regional Cancer Control, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Seiji Adachi
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan.
| | - Yohei Horibe
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Tomohiko Ohno
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Masatoshi Mabuchi
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Yusuke Suzuki
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Osamu Yamauchi
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Eri Takada
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Midori Iwama
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Koshiro Saito
- Department of Gastroenterology/Internal Medicine, Gihoku Kosei Hospital, 1187-3 Takatomi, Yamagata, 501-2105, Japan
| | - Masamichi Arao
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Koji Takai
- Division for Regional Cancer Control, Gifu University Graduate School of Medicine, Gifu, Japan.,Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Araki
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masahito Shimizu
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
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21
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Benton SC, Symonds E, Djedovic N, Jones S, Deprez L, Kocna P, Maria Auge J. Faecal immunochemical tests for haemoglobin: Analytical challenges and potential solutions. Clin Chim Acta 2021; 517:60-65. [PMID: 33571484 DOI: 10.1016/j.cca.2021.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/14/2021] [Accepted: 01/27/2021] [Indexed: 12/24/2022]
Abstract
Quantitative faecal immunochemical tests for haemoglobin (FIT) are being used increasingly around the world in colorectal cancer screening programmes, and in patients presenting with lower bowel symptoms to determine who should proceed to further bowel visualisation investigations, usually colonoscopy. The clinical utility of FIT is well reported. There are a number of analytical challenges including pre-analytical variation, difficulty setting up external quality assessment schemes, access to third party internal quality control material and a lack of standardisation or harmonisation of FIT methods. Here we report the work of the International Federation of Clinical Chemistry FIT Working Group. We provide an overview of the main pre-analytical variables; discuss different approaches to external quality assurance of FIT; propose a solution to third party internal quality assurance materials and summarise the challenges of standardisation and harmonisation of FIT.
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Affiliation(s)
- Sally C Benton
- Clinical Biochemistry, Royal Surrey County Hospital/NHS Bowel Cancer Screening South of England Hub, Berkshire and Surrey Pathology Services, Guildford, Surrey, UK
| | - Erin Symonds
- Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia; Cancer Research, Flinders Health and Medical Research, Flinders University, Bedford Park, South Australia, Australia
| | - Natasha Djedovic
- Clinical Biochemistry/NHS Bowel Cancer Screening London Hub, London North West University Healthcare NHS Trust, UK
| | - Samantha Jones
- Weqas, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Liesbet Deprez
- European Commission, Joint Research Centre (JRC), Geel, Belgium
| | - Petr Kocna
- Laboratory of Gastroenterology, Institute of Medical Biochemistry and Laboratory Diagnostics, 1st.Medical Faculty of Charles University and General University Hospital, Prague, Czech Republic
| | - Josep Maria Auge
- Clinical Chemistry and Molecular Genetics Department, Hospital Clinic, Barcelona, Catalonia, Spain
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22
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Arasaradnam RP, Bhala N, Evans C, Greenaway J, Logan R, Penman I, Seward E, Singh B, Smith S, Stephenson JA, Waugh N. Faecal immunochemical testing in the COVID-19 era: balancing risk and costs. Lancet Gastroenterol Hepatol 2020; 5:717-719. [PMID: 32526209 PMCID: PMC7279754 DOI: 10.1016/s2468-1253(20)30185-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Ramesh P Arasaradnam
- Department of Gastroenterology, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Warwick, UK.
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospital Birmingham Foundation Trust, Birmingham, UK
| | - Charles Evans
- Department of Colorectal Surgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - John Greenaway
- Department of Gastroenterology, South Tees NHS Trust, Teesside, UK
| | - Robert Logan
- Department of Gastroenterology, Kings College Hospital, London, UK
| | - Ian Penman
- Department of Gastroenterology, Royal Edinburgh Hospital, Edinburgh, UK
| | - Edward Seward
- Department of Gastroenterology, University College London, London, UK
| | - Baljit Singh
- Department of Colorectal Surgery, University Hospital Leicester NHS Trust, Leicester, UK
| | - Steve Smith
- Midlands and North West NHS England Bowel Cancer Screening Programme Hub, Rugby, UK
| | - James A Stephenson
- Department of Radiology, University Hospital Leicester NHS Trust, Leicester, UK
| | - Norman Waugh
- Warwick Medical School, University of Warwick, Warwick, UK
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23
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Symonds EL, Cornthwaite K, Fraser RJL, Bampton P, Cock C, Young GP. Reducing the number of surveillance colonoscopies with faecal immunochemical tests. Gut 2020; 69:784-785. [PMID: 30808647 DOI: 10.1136/gutjnl-2019-318370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/10/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Erin L Symonds
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia.,Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Kathryn Cornthwaite
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia
| | - Robert J L Fraser
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia.,Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Peter Bampton
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Charles Cock
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia
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24
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Digby J, Cleary S, Gray L, Datt P, Goudie DR, Steele RJC, Strachan JA, Humphries A, Fraser CG, Mowat C. Faecal haemoglobin can define risk of colorectal neoplasia at surveillance colonoscopy in patients at increased risk of colorectal cancer. United European Gastroenterol J 2020; 8:559-566. [PMID: 32213041 PMCID: PMC7268942 DOI: 10.1177/2050640620913674] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Quantitative faecal immunochemical tests measure faecal haemoglobin concentration (f-Hb), which increases in the presence of colorectal neoplasia. Objective We examined the diagnostic accuracy of faecal immunochemical test (FIT)in patients at increased risk of colorectal cancer (CRC) attending for surveillance colonoscopy as per national guidelines. Methods A total of 1103 consecutive patients were prospectively invited to complete a FIT before their scheduled colonoscopy in two university hospitals in 2014– 2016. F-Hb was analysed on an OC-Sensor io automated analyser (Eiken Chemical Co., Ltd, Tokyo, Japan) with a limit of detection of 2 µg Hb/g faeces. The diagnostic accuracy of f-Hb for CRC and higher-risk adenoma was examined. Results A total of 643 patients returned a faecal test. After excluding 4 patients with known inflammatory bowel disease, 639 (57.9%) remained in the study: age range: 25–90 years (median: 64 years, interquartile range (IQR): 55–71): 54.6% male. Of 593 patients who also completed colonoscopy, 41 (6.9%) had advanced neoplasia (4 CRC, 37 higher-risk adenoma). Of the 238 patients (40.1%) who had detectable f-Hb, 31 (13.0%) had advanced neoplasia (2 CRC, 29 higher-risk adenoma) compared with 10 (2.8%) in those with undetectable f-Hb (2 CRC, 8 higher-risk adenoma). Detectable f-Hb gave negative predictive values of 99.4% for CRC and 97.2% for CRC plus higher-risk adenoma. Conclusion In patients at increased risk of CRC under colonoscopy surveillance, a test measuring faecal haemoglobin can provide an objective estimate of the risk of advanced neoplasia, and could enable tailored scheduling of colonoscopy.
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Affiliation(s)
- Jayne Digby
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
| | - Shirley Cleary
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Lynne Gray
- Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Pooja Datt
- Department of Gastroenterology, St. Mark's Hospital and Imperial College, London, UK
| | - David R Goudie
- Department of Clinical Genetics, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Robert J C Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
| | - Judith A Strachan
- Department of Blood Sciences, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Adam Humphries
- Department of Gastroenterology, St. Mark's Hospital and Imperial College, London, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
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25
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Haug U, Senore C, Corley DA. Promises and Potential Pitfalls of Shared Decision Making in Cancer Screening. Gastroenterology 2020; 158:802-805. [PMID: 31812511 DOI: 10.1053/j.gastro.2019.11.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/04/2019] [Accepted: 11/16/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS and, Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Carlo Senore
- SSD Epidemiologia e screening - CPO, University Hospital 'Città della Salute e della Scienza', Turin, Italy
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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26
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Senore C, Zappa M, Campari C, Crotta S, Armaroli P, Arrigoni A, Cassoni P, Colla R, Fracchia M, Gili F, Grazzini G, Lolli R, Menozzi P, Orione L, Polizzi S, Rapi S, Riggi E, Rubeca T, Sassatelli R, Visioli C, Segnan N. Faecal haemoglobin concentration among subjects with negative FIT results is associated with the detection rate of neoplasia at subsequent rounds: a prospective study in the context of population based screening programmes in Italy. Gut 2020; 69:523-530. [PMID: 31455608 DOI: 10.1136/gutjnl-2018-318198] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 08/07/2019] [Accepted: 08/11/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To estimate the predictive role of faecal haemoglobin (f-Hb) concentration among subjects with faecal immunochemical test (FIT) results below the positivity cut-off for the subsequent risk of advanced neoplasia (AN: colorectal cancer-CRC-or advanced adenoma). DESIGN Prospective cohort of subjects aged 50-69 years, undergoing their first FIT between 1 January 2004 and 31 December 2010 in four population-based programmes in Italy. METHODS All programmes adopted the same analytical procedure (OC Sensor, Eiken Japan), performed every 2 years, on a single sample, with the same positivity cut-off (20 µg Hb/g faeces). We assessed the AN risk at subsequent exams, the cumulative AN detection rate (DR) over the 4-year period following the second FIT and the interval CRC (IC) risk following two negative FITs by cumulative amount of f-Hb concentration over two consecutive negative FITs, using multivariable logistic regression models and the Kaplan-Meier method. RESULTS The cumulative probability of a positive FIT result over the subsequent two rounds ranged between 7.8% (95% CI 7.5 to 8.2) for subjects with undetectable f-Hb at the initial two tests (50% of the screenees) and 48.4% (95% CI 44.0 to 53.0) among those (0.7% of the screenees) with a cumulative f-Hb concentration ≥20 µg/g faeces. The corresponding figures for cumulative DR were: 1.4% (95% CI 1.3 to 1.6) and 25.5% (95% CI 21.4 to 30.2) for AN; 0.17% (95% CI 0.12 to 0.23) and 4.5% (95% CI 2.8 to 7.1) for CRC. IC risk was also associated with cumulative f-Hb levels. CONCLUSION The association of cumulative f-Hb concentration with subsequent AN and IC risk may allow to design tailored strategies to optimise the utilisation of endoscopy resources: subjects with cumulative f-Hb concentration ≥20 µg/g faeces over two negative tests could be referred immediately for total colonoscopy (TC), while screening interval might be extended for those with undetectable f-Hb.
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Affiliation(s)
- Carlo Senore
- SSD Epidemiologia e screening - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Marco Zappa
- Clinical Epidemiology Unit, ISPRO, Florence, Italy
| | - Cinzia Campari
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Paola Armaroli
- SSD Epidemiologia e screening - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Arrigo Arrigoni
- University Gastroenterology Unit, Ospedale San Giovanni Antica Sede, Turin, Italy
| | - Paola Cassoni
- Department of Medical Sciences, Universita degli Studi di Torino, Turin, Italy
| | - Rossana Colla
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mario Fracchia
- Gastroenterology Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Fabrizio Gili
- Colorectal Cancer Screening Laboratory, University Hospital Città della Salute e della Scienza, Turin, Italy
| | | | - Roberto Lolli
- Gastroenterology Unit, Regional Hospital, Aosta, Italy
| | | | | | | | | | - Emilia Riggi
- SSD Epidemiologia e screening - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
| | | | | | | | - Nereo Segnan
- SSD Epidemiologia e screening - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
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27
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Kuipers EJ, Grobbee EJ. Personalised screening for colorectal cancer, ready for take-off. Gut 2020; 69:403-404. [PMID: 31615837 DOI: 10.1136/gutjnl-2019-319677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ernst J Kuipers
- Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esmée J Grobbee
- Department of Gastroenterology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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28
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Kooyker AI, Toes-Zoutendijk E, Opstal-van Winden AWJ, Spaander MCW, Buskermolen M, van Vuuren HJ, Kuipers EJ, van Kemenade FJ, Ramakers C, Thomeer MGJ, Dekker E, Nagtegaal ID, de Koning HJ, van Leerdam ME, Lansdorp-Vogelaar I. The second round of the Dutch colorectal cancer screening program: Impact of an increased fecal immunochemical test cut-off level on yield of screening. Int J Cancer 2020; 147:1098-1106. [PMID: 31853977 PMCID: PMC7383838 DOI: 10.1002/ijc.32839] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/18/2022]
Abstract
The Dutch colorectal cancer (CRC) screening program started in 2014, inviting the target population biennially to perform a fecal immunochemical test (FIT). We obtained prospectively collected data from the national screening information‐system to present the results of the second round (2016) and evaluate the impact of increasing the FIT cut‐off halfway through the first round from 15 to 47 μg Hb/g feces on outcomes in the second round. Second round screening was done with a 47 μg Hb/g feces FIT cut‐off. Participants were classified based on first round participation status as either FIT (15,47) or FIT (47,47) participants, and previous nonparticipants. In total, 348,891 (75.9%) out of 459,740 invitees participated in the second round. Participation rates were 93.4% among previous participants and 21.0% among previous non‐participants. FIT(47,47) participants had a significantly higher detection rate of AN (15.3 vs. 10.4 per 1,000 participants) compared to FIT(15,47) participants in the second round, while their cumulative detection rate of AN over two rounds was significantly lower (45.6 vs. 52.6 per 1,000 participants). Our results showed that participation in the Dutch CRC screening program was consistently high and that second round detection rates depended on the first round FIT cut‐off. The cumulative detection over two rounds was higher among FIT(15,47) participants. These findings suggest that a substantial part of, but not all the missed findings in the first round due to the increased FIT cut‐off were detected in the subsequent round. What's new? In 2014, the Netherlands implemented colorectal cancer (CRC) screening based on non‐invasive fecal immunochemical testing (FIT), which offers a practical approach for population‐based CRC detection. In the Dutch program's first round, to match local resources, FIT cut‐off was increased, resulting in reduced positivity rates and reduced colonoscopy referrals, at the cost of missing advanced neoplasias. The current study shows that many of these missed advanced neoplasias were detected in subsequent screening, suggesting that increased FIT cut‐off had marginal impact on screening outcome. The findings could benefit other CRC screening programs in establishing effective FIT cut‐offs.
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Affiliation(s)
- Arthur I Kooyker
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maaike Buskermolen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hanneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Chris Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maarten G J Thomeer
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers - Academic Medical Center, Amsterdam, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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29
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Fraser CG, Benton SC. Detection capability of quantitative faecal immunochemical tests for haemoglobin (FIT) and reporting of low faecal haemoglobin concentrations. Clin Chem Lab Med 2019; 57:611-616. [PMID: 29995629 DOI: 10.1515/cclm-2018-0464] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/05/2018] [Indexed: 01/25/2023]
Abstract
Faecal immunochemical tests for haemoglobin (FIT) are widely used in asymptomatic population screening for colorectal (bowel) cancer. FIT are also used to assist with the assessment of patients presenting with lower abdominal symptoms. Quantitative FIT allow the generation of numerical estimates of faecal haemoglobin (f-Hb) concentrations. There is now great interest in "low" f-Hb concentrations in these clinical settings: in consequence, knowledge of the detection capability is very important for f-Hb concentration examinations. There are a number of current problems associated with the reporting of low f-Hb concentrations and wide misunderstanding of the metrological aspects of examinations of f-Hb at low concentrations. These would be solved if the detectability characteristics of f-Hb concentration examinations, namely, the limit of blank (LoB), limit of detection (LoD) and limit of quantitation (LoQ), were generated, validated and used in reporting systems exactly as recommended in the EP17-A2 guideline of the Clinical Laboratory Standards Institute. LoB and LoD are statistical concepts, but the LoQ depends on definition of analytical performance specifications (APS). In this Opinion Paper proposals for interim APS are made, based on the current state of the art achieved with examinations of faecal samples. It is proposed that LoQ is determined at an examination imprecision of CV≤10% using faecal samples naturally positive for Hb rather than faeces spiked with haemolysate. Detailed proposals for reporting f-Hb data at low concentrations are also made.
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Affiliation(s)
- Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK
| | - Sally C Benton
- NHS Bowel Cancer Screening Programme, Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
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Murphy CC, Sen A, Watson B, Gupta S, Mayo H, Singal AG. A Systematic Review of Repeat Fecal Occult Blood Tests for Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2019; 29:278-287. [PMID: 31740521 DOI: 10.1158/1055-9965.epi-19-0775] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/29/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Screening with fecal occult blood tests (FOBT) reduces colorectal cancer mortality. Failure to complete repeat tests may compromise screening effectiveness. We conducted a systematic review of repeat FOBT across diverse health care settings. We searched MEDLINE, Embase, and the Cochrane Library for studies published from 1997 to 2017 and reported repeat FOBT over ≥2 screening rounds. Studies (n = 27 reported in 35 articles) measured repeat FOBT as (i) proportion of Round 1 participants completing repeat FOBT in Round 2; (ii) proportion completing two, consecutive FOBT; or (iii) proportion completing ≥3 rounds. Among those who completed FOBT in Round 1, 24.6% to 89.6% completed repeat FOBT in Round 2 [median: 82.0%; interquartile range (IQR): 73.7%-84.6%]. The proportion completing FOBT in two rounds ranged from 16.4% to 80.0% (median: 46.6%; IQR: 40.5%-50.0%), and in studies examining ≥3 rounds, repeat FOBT ranged from 0.8% to 64.1% (median: 39.2%; IQR: 19.7%-49.4%). Repeat FOBT appeared higher in mailed outreach (69.1%-89.6%) compared with opportunistic screening (24.6%-48.6%). Few studies examined correlates of repeat FOBT. In summary, we observed a wide prevalence of repeat FOBT, and prevalence generally declined in successive screening rounds. Interventions that increase and maintain participation in FOBT are needed to optimize effectiveness of this screening strategy.
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Affiliation(s)
- Caitlin C Murphy
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas.
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Ahana Sen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Bianca Watson
- Department of Psychiatry and Behavioral Sciences, Tulane School of Medicine, New Orleans, Louisiana
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, UC San Diego, San Diego, California
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, UT Southwestern Medical Center, Dallas Texas
| | - Amit G Singal
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
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31
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Flugelman AA, Stein N, Segol O, Lavi I, Keinan-Boker L. Delayed Colonoscopy Following a Positive Fecal Test Result and Cancer Mortality. JNCI Cancer Spectr 2019; 3:pkz024. [PMID: 31360901 PMCID: PMC6649710 DOI: 10.1093/jncics/pkz024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/12/2019] [Accepted: 03/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background A fecal test followed by diagnostic colonoscopy for a positive result is a widely endorsed screening strategy for colorectal cancer (CRC). However, the relationship between the time delay from the positive test to the follow-up colonoscopy and CRC mortality has not been established. Methods From a population-based screening program, we identified CRC patients newly diagnosed from 2005 through 2015 by a positive fecal occult test followed by a colonoscopy. The primary outcome measure was CRC-specific mortality according to four categories for the time elapsed between the positive result and the subsequent colonoscopy. Results The 1749 patients underwent colonoscopies within 0–3 months (n = 981, 56.1%), 4–6 months (n = 307, 17.5%), 7–12 months (n = 157, 9.0%), and later than 12 months (n = 304, 17.4%). CRC-specific deaths according to exposure groups were: 13.8% (135 of 981) for 0–3 months, 10.7% (33 of 307) for 4–6 months (crude hazards ratio [HR] = 0.74, 95% confidence interval [CI] = 0.51 to 1.14), 11.5% (18 of 157) for 7–12 months (crude HR = 0.83, 95% CI = 0.51 to 1.42), and 22.7% (69 of 304) for longer than 12 months (crude HR = 1.40, 95% CI = 1.04 to 1.90). The only variable that was associated with mortality risk was the number of positive slides (P = .003). High positivity was twice the value in the 0–3 as the longer-than-12 months group: 51.9% vs 25.0% and similar for the 4–6 and 7–12 months groups (38.1% and 36.5%), respectively. The adjusted HRs for CRC mortality were 0.81 (95% CI = 0.55 to 1.19); 0.83 (95% CI = 0.50 to 1.41), and 1.53 (95% CI = 1.13 to 2.12, P = .006) for the 4–12, 7–12, and longer-than-12-months groups, respectively, compared with the shortest delay group. Conclusions Among screen-diagnosed CRC patients, performance of colonoscopy more than 12 months after the initial positive fecal occult blood test was associated with more advanced disease and higher mortality due to CRC.
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Affiliation(s)
- Anath A Flugelman
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Clalit National Cancer Control Center, Haifa, Israel
| | - Nili Stein
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Clalit National Cancer Control Center, Haifa, Israel
| | - Ori Segol
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Gastroenterology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel.,Clalit National Cancer Control Center, Haifa, Israel
| | - Lital Keinan-Boker
- Israel National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,School of Public Health, University of Haifa, Haifa, Israel
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32
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Spaander MCW, Kuipers EJ. Effects of Oral Anticoagulant and Aspirin Use on Ability of Fecal Immunochemical Tests to Detect Advanced Neoplasia. Gastroenterology 2019; 156:1553-1555. [PMID: 30926342 DOI: 10.1053/j.gastro.2019.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Manon C W Spaander
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Ernst J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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33
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Gibson DJ, Mooney T, Mooney J, Mulcahy HE, O'Donoghue D. Impact of a higher fecal immunochemistry test cut-off on pathology detected in subsequent rounds of a colorectal screening program. Gastrointest Endosc 2019; 89:518-522. [PMID: 30142350 DOI: 10.1016/j.gie.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening is superior to the traditional binary fecal occult blood test. Its quantitative nature allows the investigator to choose a positivity threshold to match cost and endoscope capacity. The optimal threshold is still debated. BowelScreen, the Irish national colorectal cancer screening program, has a cut-off of 45 μg Hb/g feces, and in this study we investigated the impact of this threshold on pathology detected in round 2 in individuals who had a negative result for round 1 FIT (FIT1). METHODS All individuals with a negative FIT1 result who completed a round 2 FIT (FIT2) 2 years later were included. Pathology outcomes for individuals who had positive FIT2 results were correlated with FIT1 levels. RESULTS A total of 37,877 individuals had negative FIT1 results and completed FIT2. One thousand two hundred thirty (3.2%) had positive FIT2 results (702 men [57%], median age 69, age range 60-70 years). Quantitative analysis showed that at an FIT1 level <5 μg Hb/g feces, 2.3% had positive FIT2 results. At a higher cut-off of 40.1 to 45 μg Hb/g feces, 15.6% of individuals had positive FIT2 results. One thousand two (81.5%) underwent colonoscopy, with clinical outcomes in all cases. Three hundred fifty-one (35%) had normal colonoscopy results. The proportion of individuals with normal colonoscopy results decreased as FIT1 levels rose. Conversely, advanced pathology (CRC + high-risk adenomas) rates rose from 7% to 50% when FIT1 was <5 compared with 40.1 to 45 μg Hb/g feces, respectively. There were 51 screen-detected cancers in round 2 among individuals with negative FIT1 results (22 stage I, 12 stage II, 14 stage III, 3 stage IV). All 3 stage IV individuals had FIT1 results <20 μg Hb/g feces. CONCLUSIONS Varying rates of pathology are observed in round 2 of a screening program based on the quantitative level of a negative round 1 FIT result when the positivity threshold is relatively high. A CRC rate of 5.1% within this group appears acceptable. Although patients with incurable cancer were observed, the positivity threshold to capture these cases within round 1 would have been so sensitive that it would create an unsustainable endoscopy referral burden.
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Affiliation(s)
- David J Gibson
- BowelScreen, The National Bowel Screening Programme, Dublin, Ireland
| | - Therese Mooney
- BowelScreen, The National Bowel Screening Programme, Dublin, Ireland
| | - Jennifer Mooney
- BowelScreen, The National Bowel Screening Programme, Dublin, Ireland
| | - Hugh E Mulcahy
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland
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34
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Estrogen enhances female small intestine epithelial organoid regeneration. JOURNAL OF BIO-X RESEARCH 2019. [DOI: 10.1097/jbr.0000000000000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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35
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Amitay EL, Cuk K, Niedermaier T, Weigl K, Brenner H. Factors associated with false‐positive fecal immunochemical tests in a large German colorectal cancer screening study. Int J Cancer 2019; 144:2419-2427. [DOI: 10.1002/ijc.31972] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Efrat L. Amitay
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ) Heidelberg Germany
| | - Katarina Cuk
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ) Heidelberg Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ) Heidelberg Germany
- Heidelberg Medical FacultyHeidelberg University Heidelberg Germany
| | - Korbinian Weigl
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ) Heidelberg Germany
- Heidelberg Medical FacultyHeidelberg University Heidelberg Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Heidelberg Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ) Heidelberg Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Heidelberg Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg Germany
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36
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Buron A, Román M, Augé JM, Macià F, Grau J, Sala M, Louro J, Martinez-Alonso M, Alvarez-Urturi C, Andreu M, Bessa X, Zaffalon D, Castells A, Pellisé M, Aldea M, Rivero L, Hernández C, Torá-Rocamora I, Castells X. Changes in FIT values below the threshold of positivity and short-term risk of advanced colorectal neoplasia: Results from a population-based cancer screening program. Eur J Cancer 2019; 107:53-59. [DOI: 10.1016/j.ejca.2018.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 12/24/2022]
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37
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Libby G, Fraser CG, Carey FA, Brewster DH, Steele RJC. Occult blood in faeces is associated with all-cause and non-colorectal cancer mortality. Gut 2018; 67:2116-2123. [PMID: 30012724 PMCID: PMC6241609 DOI: 10.1136/gutjnl-2018-316483] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE An association between detectable faecal haemoglobin (f-Hb) and both the risk of death from colorectal cancer (CRC) and all-cause mortality has been reported. We set out to confirm or refute this observation in a UK population and to explore the association between f-Hb, as indicated by a positive guaiac faecal occult blood test (gFOBT) result, and different causes of death. DESIGN All individuals (134 192) who participated in gFOBT screening in Tayside, Scotland between 29/03/2000 and 29/03/2016 were studied by linking their test result (positive or negative) with mortality data from the National Records of Scotland database and following to 30/03/2016. RESULTS Those with a positive test result (n=2714) had a higher risk of dying than those with a negative result, from CRC: HR 7.79 (95% CI 6.13 to 9.89), p<0.0001, (adjusted for, gender, age, deprivation quintile and medication that can cause bleeding) and all non-CRC causes: HR 1.58 (95% CI 1.45 to 1.73), p<0·0001.· In addition, f-Hb detectable by gFOBT was significantly associated with increased risk of dying from circulatory disease, respiratory disease, digestive diseases (excluding CRC), neuropsychological disease, blood and endocrine disease and non-CRC. CONCLUSION The presence of detectable f-Hb is associated with increased risk of death from a wide range of causes.
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Affiliation(s)
- Gillian Libby
- Bowel Screening Research Unit, Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Division of Cancer, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Callum G Fraser
- Bowel Screening Research Unit, Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Division of Cancer, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Frank A Carey
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - David H Brewster
- Scottish Cancer Registry, National Services Division, Edinburgh, Scotland
| | - Robert J C Steele
- Bowel Screening Research Unit, Centre for Research into Cancer Prevention and Screening, Medical Research Institute, Division of Cancer, Ninewells Hospital and Medical School, Dundee, Scotland
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Li C, Li W, Zhang Y, Zhang X, Liu T, Zhang Y, Yang Y, Wang L, Pan H, Ji J, Wang C. Increased expression of antisense lncRNA SPINT1-AS1 predicts a poor prognosis in colorectal cancer and is negatively correlated with its sense transcript. Onco Targets Ther 2018; 11:3969-3978. [PMID: 30022840 PMCID: PMC6044340 DOI: 10.2147/ott.s163883] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Colorectal cancer (CRC) is a leading cause of cancer-associated mortality worldwide. Natural antisense transcripts (NATs) are pervasively expressed in human genome and have been confirmed to contribute to cancer progression. In our study, we aimed to investigate the expression and clinical pertinence of serine peptidase inhibitor, Kunitz type 1 antisense RNA1 (SPINT1-AS1) in CRC. Materials and methods The expression levels of SPINT1-AS1 and the corresponding sense transcript SPINT1 mRNA were analyzed in 150 pairs of CRC tissues and adjacent normal (AN) tissues, along with 45 pairs of preoperative and postoperative serum exosome samples by the strand-specific real-time quantitative polymerase chain reaction. Results Compared with AN tissues, the expression of SPINT1-AS1 was increased (P<0.001, 3.771 vs 0.980) in CRC tissues, while SPINT1 mRNA expression was decreased in CRC (P<0.001, 0.927 vs 1.165), and there was an obviously negative correlation between SPINT1-AS1 expression and its sense transcript (r=-0.701, P<0.001). SPINT1-AS1 yielded an area under the receiver operating characteristic curve value of 0.865 (95% confidence interval, 0.821-0.902) for discriminating CRC tissues from AN tissues. Moreover, high SPINT1-AS1 expression was correlated with regional lymph node metastasis (P<0.001), distant metastasis (P<0.001), and shorter relapse-free survival (RFS) time (P<0.001), and Cox regression analysis indicated that SPINT1-AS1 was an independent prognostic factor for RFS. Meanwhile, significant reduction of SPINT1-AS1 expression level (P=0.001) was observed in CRC serum exosomes after surgical resection. Conclusion SPINT1-AS1 is upregulated in CRC tissues and plays an essential role in CRC progression and prognosis. Thereby, SPINT1-AS1 may serve as a candidate prognostic biomarker and molecular therapy target for CRC.
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Affiliation(s)
- Chen Li
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan 250033, China,
| | - Wei Li
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Yanli Zhang
- Department of Clinical Laboratory, Shandong Provincial Third Hospital, Jinan, 250031, China
| | - Xin Zhang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Tong Liu
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan 250033, China,
| | - Yi Zhang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Yongmei Yang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Lili Wang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Hongwei Pan
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Jian Ji
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Chuanxin Wang
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan 250033, China,
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39
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Affiliation(s)
- Ernst J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands.
| | - Manon C Spaander
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
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40
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Fraser CG. Faecal immunochemical tests (FIT) in the assessment of patients presenting with lower bowel symptoms: Concepts and challenges. Surgeon 2018; 16:302-308. [PMID: 29548552 DOI: 10.1016/j.surge.2018.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/30/2018] [Indexed: 12/25/2022]
Abstract
Colonoscopy is a relatively scarce resource in many countries, including Scotland, and a simple investigation which would aid general practitioners in particular in decision-making as to which patients presenting with lower bowel symptoms warranted referral would be of much help. Faecal immunochemical tests for haemoglobin (FIT) have many advantageous characteristics and are now proven to be of considerable value in the timely assessment of patients with symptoms of lower bowel disease. Quantitative FIT provide numerical estimates of faecal haemoglobin concentration (f-Hb) and, at low f-Hb cut-off, FIT have high sensitivity for colorectal cancer (CRC) and could be used as a rule-in test to stimulate rapid referral, especially when symptoms are suggestive of serious bowel disease. Perhaps more importantly, a low f-Hb gives considerable reassurance that significant bowel disease (CRC + higher-risk adenoma + inflammatory bowel disease) is absent and further investigation may not be warranted: however, no test is perfect, so some cases will remain undetected using FIT alone and robust safety netting is required, possibly including watching and waiting, referral to clinics in secondary care, or a repeat FIT. Moreover, the FIT results should not be taken in isolation, but clinical impressions and the results of other investigations, probably including the full blood count, should be considered. Challenges still exist, however, and harmonisation of aspects of the available FIT analytical systems is required. Moreover, a number of seemingly valid clinical concerns remain and these require resolution through further research and reporting of studies done in real clinical practice.
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Affiliation(s)
- Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, UK.
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