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Laven-Law G, Symonds EL, Winter JM, Chen G, Flight IH, Hughes-Barton D, Wilson CJ, Young GP. Comparing a fecal immunochemical test and circulating tumor DNA blood test for colorectal cancer screening adherence. J Gastroenterol Hepatol 2024. [PMID: 38430185 DOI: 10.1111/jgh.16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/20/2023] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND AND AIM Colorectal cancer (CRC) screening programs are most effective at reducing disease incidence and mortality through sustained screening participation. A novel blood test modality is being explored for CRC screening, but it is unclear whether it will provide sustained screening participation. This study aimed to investigate whether a circulating tumor DNA (ctDNA) blood test improved CRC screening re-participation when compared with a fecal immunochemical test (FIT) and to define the predictors of sustained CRC screening in an Australian population. METHODS South Australians who initially participated in CRC screening using a ctDNA blood test (n = 36) or FIT (n = 547) were offered the same CRC screening test approximately 2 years later through an extended phase of a randomized controlled trial. Surveys collected demographic, psychosocial, and clinical information. Predictors of CRC screening re-participation were explored using chi-square, Wilcoxon tests, and logistic regression. RESULTS Participants offered a second ctDNA blood test were equally likely to re-participate in CRC screening as those who completed a FIT in the first round and who were offered the same test (61% vs 66% re-participation respectively, P = 0.6). CRC fatalism, health activation, and self-efficacy were associated with repeated screening participation. Test awareness was predictive of repeated FIT-based CRC screening. CONCLUSIONS Targeted interventions to improve CRC screening awareness and increase patient health activation may improve CRC screening adherence. A ctDNA blood test may be a suitable CRC screening option to maintain CRC screening adherence in people who do not participate in screening with FIT.
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Affiliation(s)
- Geraldine Laven-Law
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Erin L Symonds
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Jean M Winter
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caulfield East, Victoria, Australia
| | - Ingrid H Flight
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Donna Hughes-Barton
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Carlene J Wilson
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Graeme P Young
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
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2
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Hansen LØ, Fürst MB, Bjørsum-Meyer T, Schelde-Olesen B, Deding U, Kaalby L. Factors associated with negative colonoscopy in participants with a positive faecal immunochemical test from the Danish Colorectal Cancer Screening Program - a population-based study. Colorectal Dis 2024; 26:476-485. [PMID: 38297072 DOI: 10.1111/codi.16886] [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: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/06/2024] [Indexed: 02/02/2024]
Abstract
AIM In the Danish Colorectal Cancer Screening Program (DCCSP), 37% of participants undergoing colonoscopy have a negative result with no obvious findings that can be attributed to a positive faecal immunochemical test (FIT). The aim of this work was to identify predictors for a negative colonoscopy in DCCSP participants with a positive FIT. METHOD We included 73 655 FIT-positive DCCSP participants using the Danish Colorectal Cancer Screening Database and linked their screening results with data from several other national health registers. We stratified participants by all predictors, and compared them using multivariate logistic regression analysis. Results are reported as odds ratios (ORs). RESULTS We found that having a condition linked to gastrointestinal bleeding, for example fissures, haemorrhoids and inflammatory bowel disease, was strongly associated with the probability of having a negative colonoscopy [OR 2.77 (95% CI 2.59, 2.96)]. FIT concentration was inversely related to the probability of a negative colonoscopy, the OR decreased steadily from 0.79 (95% CI 0.75, 0.83) in the 40-59 μg/g group, to 0.44 (95% CI 0.42, 0.46) in the ≥200 μg/g group. Women had a 1.64 (95% CI 1.59, 1.70) times higher probability of a negative colonoscopy than men. CONCLUSION Our findings indicate that baseline conditions linked to gastrointestinal bleeding are an associating factor with having a negative colonoscopy. The same is true for low FIT concentration and female sex. Further studies with similar findings could suggest that an incorporation of these factors into a personalized screening approach by differentiating between diagnostic modalities could improve the process for the participant while alleviating the health care system.
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Affiliation(s)
| | | | - Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Benedicte Schelde-Olesen
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ulrik Deding
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lasse Kaalby
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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3
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Saw KS, Sexton K, Frankish P, Hulme-Moir M, Bissett I, Parry S. Interval colorectal cancers after negative faecal immunochemical test in the New Zealand Bowel Screening Pilot. BMJ Open Gastroenterol 2023; 10:e001233. [PMID: 38007223 PMCID: PMC10679982 DOI: 10.1136/bmjgast-2023-001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/02/2023] [Indexed: 11/27/2023] Open
Abstract
OBJECTIVE Evaluate the diagnostic performance of faecal immunochemical test (FIT), identify risk factors for FIT-interval colorectal cancers (FIT-IC) and describe long-term outcomes of participants with colorectal cancers (CRC) in the New Zealand Bowel Screening Pilot (BSP). DESIGN From 2012 to 2017, the BSP offered eligible individuals, aged 50-74 years, biennial screening using a quantitative FIT with positivity threshold of 15 µg haemoglobin (Hb)/g faeces. Retrospective review of prospectively maintained data extracted from the BSP Register and New Zealand Cancer Registry identified any CRC reported in participants who returned a definitive FIT result. Further details were obtained from hospital records. FIT-ICs were primary CRC diagnosed within 24 months of a negative FIT. Factors associated with FIT-ICs were identified using logistic regression. RESULTS Of 387 215 individuals invited, 57.4% participated with 6.1% returning positive FIT results. Final analysis included 520 CRC, of which 111 (21.3%) met FIT-IC definition. Overall FIT sensitivity for CRC was 78.7% (95% CI=74.9% to 82.1%), specificity was 94.1% (95% CI=94.0% to 94.2%). In 78 (70.3%) participants with FIT-IC, faecal Hb was reported as undetectable. There were no significant associations between FIT-IC and age, sex, ethnicity and deprivation. FIT-ICs were significantly associated with proximal tumour location, late stage at diagnosis, high-grade tumour differentiation and subsequent round screens. Median follow-up time was 74 (2-124) months. FIT-IC had significantly poorer overall survival. CONCLUSION FIT sensitivity in BSP compared favourably to published data. FIT-ICs were more likely to be proximal tumours with poor long-term outcomes. Further lowering of FIT threshold would have minimal impact on FIT-IC.
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Affiliation(s)
- Kai Sheng Saw
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kerry Sexton
- National Screening Unit, New Zealand Ministry of Health, Wellington, New Zealand
| | - Paul Frankish
- Department of Gastroenterology, Te Whatu Ora - Health New Zealand Waitemata, Takapuna, New Zealand
| | - Mike Hulme-Moir
- Department of Surgery, Te Whatu Ora - Health New Zealand Waitemata, Takapuna, New Zealand
| | - Ian Bissett
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Parry
- National Screening Unit, New Zealand Ministry of Health, Wellington, New Zealand
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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4
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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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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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Dasgupta P, Cameron JK, Goodwin B, Cramb SM, Mengersen K, Aitken JF, Baade PD. Geographical and spatial variations in bowel cancer screening participation, Australia, 2015-2020. PLoS One 2023; 18:e0288992. [PMID: 37471422 PMCID: PMC10358922 DOI: 10.1371/journal.pone.0288992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Participation in bowel cancer screening programs remains poor in many countries. Knowledge of geographical variation in participation rates may help design targeted interventions to improve uptake. This study describes small-area and broad geographical patterns in bowel screening participation in Australia between 2015-2020. METHODS Publicly available population-level participation data for Australia's National Bowel Cancer Screening Program (NBCSP) were modelled using generalized linear models to quantify screening patterns by remoteness and area-level disadvantage. Bayesian spatial models were used to obtain smoothed estimates of participation across 2,247 small areas during 2019-2020 compared to the national average, and during 2015-2016 and 2017-2018 for comparison. Spatial heterogeneity was assessed using the maximized excess events test. RESULTS Overall, screening participation rates was around 44% over the three time-periods. Participation was consistently lower in remote or disadvantaged areas, although heterogeneity was evident within these broad categories. There was strong evidence of spatial differences in participation over all three periods, with little change in patterns between time periods. If the spatial variation was reduced (so low participation areas were increased to the 80th centile), an extra 250,000 screens (4% of total) would have been conducted during 2019-2020. CONCLUSIONS Despite having a well-structured evidence-based government funded national bowel cancer screening program, the substantial spatial variation in participation rates highlights the importance of accounting for the unique characteristics of specific geographical regions and their inhabitants. Identifying the reasons for geographical disparities could inform interventions to achieve more equitable access and a higher overall bowel screening uptake.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Jessica K. Cameron
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Belinda Goodwin
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- Centre for Heath Research, University of Southern Queensland, Springfield, Queensland, Australia
| | - Susanna M. Cramb
- Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kerrie Mengersen
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joanne F. Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Peter D. Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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7
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Yeh JH, Tseng CH, Wang WL, Chen CI, Liu YP, Lee YC, Wang JY, Lin YC. Performance of the Fecal Immunochemical Test in Detecting Advanced Colorectal Neoplasms and Colorectal Cancers in People Aged 40-49 Years: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15113006. [PMID: 37296969 DOI: 10.3390/cancers15113006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The incidence of early-onset colorectal cancer (CRC) is increasing. Many guidelines recommend initiating screening at 45 years. This study investigated the detection rate of advanced colorectal neoplasm (ACRN) by using fecal immunochemical tests (FITs) in individuals aged 40-49 years. METHODS PubMed, Embase, and Cochrane Library databases were searched from inception to May 2022. The primary outcomes were the detection rates and positive predictive values of FITs for ACRN and CRC in people aged 40-49 (younger age group) and ≥50 years (average risk group). RESULTS Ten studies with 664,159 FITs were included. The FIT positivity rate was 4.9% and 7.3% for the younger age and average risk groups, respectively. Younger individuals with positive FIT results had significantly higher risks of ACRN (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.79-3.73) or CRC (OR 2.86, 95% CI 1.59-5.13) than did individuals in the average-risk group, regardless of FIT results. Individuals aged 45-49 years with positive FIT results had a similar risk of ACRN (OR 0.80, 95% CI 0.49-1.29) to that of people aged 50-59 years with positive FIT results, although significant heterogeneity was observed. The positive predictive values of the FIT were 10-28.1% for ACRN and 2.7-6.8% for CRC in the younger age group. CONCLUSION The detection rate of ACRN and CRC based on FITs in individuals aged 40-49 years is acceptable, and the yield of ACRN might be similar between individuals aged 45-49 and 50-59 years. Further prospective cohort and cost-effective analysis are warranted.
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Affiliation(s)
- Jen-Hao Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA DaChang Hospital, I-Shou University, Kaohsiung 813, Taiwan
- Department of Medical Technology, College of Medicine, I-Shou University, Kaohsiung 824, Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung 813, Taiwan
| | - Cheng-Hao Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Cancer Hospital, Kaohsiung 824, Taiwan
| | - Wen-Lun Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Cancer Hospital, Kaohsiung 824, Taiwan
| | - Chih-I Chen
- Division of Colorectal Surgery, Department of Surgery, E-DA Hospital, Kaohsiung 824, Taiwan
| | - Yu-Peng Liu
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung 813, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 813, Taiwan
| | - Yi-Chia Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Jaw-Yuan Wang
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung 813, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 813, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 813, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 813, Taiwan
- Pingtung Hospital, Ministry of Health and Welfare, Pingtung 900, Taiwan
| | - Yu-Ching Lin
- Department of Family Medicine, E-DA DaChang Hospital, I-Shou University, Kaohsiung 824, Taiwan
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Reid MS, Paul HA, Mostoufi A, Robinson JL, Sadrzadeh SMH. Evaluation of the stability of fecal immunochemical test specimens. Clin Biochem 2022; 115:92-96. [PMID: 36470343 DOI: 10.1016/j.clinbiochem.2022.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022]
Abstract
Fecal immunochemical tests (FIT) are used to screen for colorectal cancer by detecting blood present in stool. Patients collect FIT specimens at home in a sampling kit and return them to the lab for testing. At our institution, patients are instructed to return their specimens to the laboratory within seven days from collection, which is shorter than the manufacturer stated room temperature (RT) stability of 15 days. The objective of this study was to assess and verify the stability of FIT specimens at RT and to determine if refrigerated storage improves stability. A series of experiments were performed with the OC-Sensor DIANA iFOB Test system between 2017 and 2019, using a positive clinical cut-off of 75 ng/mL (15 µg/g) hemoglobin (Hb). Specimens were collected and categorized based on their initially measured Hb concentration and had repeated measurements for up to 21 days following collection. FIT specimens were stored either at RT or refrigerated. Our results show that FIT specimens have reduced concentrations of Hb compared to baseline when stored at RT; refrigeration improved FIT specimen stability but did not completely prevent the reduction in Hb concentration. Additionally, specimens marginally above the cut-off (initial concentrations between 75 and 100 ng/mL (15-20 µg/g)) that were stored at RT showed 100% positivity on the day of collection (n=33), 63% on Day 3 (n=19), 46% on Days 4/5 (n=26), and 38% on Days 6/7 (n=26). Finally, specimens with Hb values near the clinical cut-off appear to be particularly susceptible to false negatives as a result of the reduction in Hb over time. Therefore, laboratories should verify the specifics of their FIT tests before offering it to patients to reduce false negatives.
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Affiliation(s)
- Michael S Reid
- Alberta Precision Laboratories, Diagnostic and Scientific Research Centre, 3535 Research Rd NW, Calgary, AB T2L 2K8, Canada; Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.
| | - Heather A Paul
- Alberta Precision Laboratories, Diagnostic and Scientific Research Centre, 3535 Research Rd NW, Calgary, AB T2L 2K8, Canada; Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.
| | - Arshia Mostoufi
- Department of Biological Sciences, University of Calgary, Calgary, AB, Canada.
| | - Jason L Robinson
- Alberta Precision Laboratories, Diagnostic and Scientific Research Centre, 3535 Research Rd NW, Calgary, AB T2L 2K8, Canada; Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada; Health PEI, Charlottetown, PEI, Canada.
| | - S M Hossein Sadrzadeh
- Alberta Precision Laboratories, Diagnostic and Scientific Research Centre, 3535 Research Rd NW, Calgary, AB T2L 2K8, Canada; Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada.
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9
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Clark GR, Steele RJ, Fraser CG. Strategies to minimise the current disadvantages experienced by women in faecal immunochemical test-based colorectal cancer screening. Clin Chem Lab Med 2022; 60:1496-1505. [DOI: 10.1515/cclm-2022-0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Currently, women are disadvantaged compared to men in colorectal cancer (CRC) screening, particularly in programmes that use faecal immunochemical tests for haemoglobin (FIT) followed by colonoscopy. Although there is no single cause for all the known disadvantages, many can be attributed to the ubiquitous finding that women have lower faecal haemoglobin concentrations (f-Hb) than men; there are many plausible reasons for this. Generally, a single f-Hb threshold is used in CRC screening programmes, leading to lower positivity for women than men, which causes poorer outcomes for women, including lower CRC detection rate, higher interval cancer (IC) proportion, and higher CRC mortality. Many of the now widely advocated risk scoring strategies do include factors taking account of sex, but these have not been extensively piloted or introduced. Using different f-Hb thresholds for the sexes seems advantageous, but there are difficulties, including deciding which characteristic should be selected to achieve equivalency, for example, positivity, IC proportions, or specificity. Moreover, additional colonoscopy resources, often constrained, would be required. Governments and their agencies should be encouraged to prioritise the allocation of resources to put simple strategies into practice, such as different f-Hb thresholds to create equal positivity in both sexes.
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Affiliation(s)
- Gavin R.C. Clark
- Centre for Research into Cancer Prevention and Screening , University of Dundee , Dundee , Scotland , UK
| | - Robert J.C. Steele
- Centre for Research into Cancer Prevention and Screening , University of Dundee , Dundee , Scotland , UK
| | - Callum G. Fraser
- Centre for Research into Cancer Prevention and Screening , University of Dundee , Dundee , Scotland , UK
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10
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Johnstone MS, Miller G, Pang G, Burton P, Kourounis G, Winter J, Crighton E, Mansouri D, Witherspoon P, Smith K, McSorley ST. Alternative diagnoses and demographics associated with a raised quantitative faecal immunochemical test in symptomatic patients. Ann Clin Biochem 2022; 59:277-287. [PMID: 35044264 PMCID: PMC9280700 DOI: 10.1177/00045632221076771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The faecal immunochemical test (FIT) has proven utility for colorectal cancer
detection in symptomatic patients. However, most patients with a raised
faecal haemoglobin (f-Hb) do not have colorectal cancer. We investigated
alternative diagnoses and demographics associated with a raised f-Hb in
symptomatic patients. Methods A retrospective, observational study was performed of patients with FIT
submitted between August 2018 to January 2019 in NHS Greater Glasgow and
Clyde followed by colonoscopy. Colonoscopy/pathology reports were searched
for alternative diagnoses. Covariables were compared using the χ2 test. Multivariate binary logistic regression identified independent
predictors of a raised f-Hb. Results 1272 patients were included. In addition to colorectal cancer (odds ratio
(OR), 9.27 (95% confidence interval (CI): 3.61–23.83; p
< 0.001)), older age (OR, 1.52 (95% CI: 1.00–2.32; p =
0.05)), deprivation (OR, 1.54 (95% CI: 1.21–1.94; p <
0.001)), oral anticoagulants (OR, 1.78 (95% CI: 1.01–3.15;
p = 0.046)), rectal bleeding (OR, 1.47 (95% CI:
1.15–1.88; p = 0.002)), advanced adenoma (OR, 7.52 (95% CI:
3.90–14.49; p < 0.001)), non-advanced polyps (OR, 1.78
(95% CI: 1.33–2.38; p < 0.001)) and inflammatory bowel
disease (IBD) (OR, 4.19 (95% CI: 2.17–8.07; p < 0.001))
independently predicted raised f-Hb. Deprivation (Scottish Index of Multiple
Deprivation (SIMD) 1-2: OR, 2.13 (95% CI: 1.38–3.29; p =
0.001)) independently predicted a raised f-Hb in patients with no pathology
found at colonoscopy. Conclusions An elevated f-Hb is independently associated with older age, deprivation,
anticoagulants, rectal bleeding, advanced adenoma, non-advanced polyps and
IBD in symptomatic patients. Deprivation is associated with a raised f-Hb in
the absence of pathology. This must be considered when utilising FIT in
symptomatic patients.
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Affiliation(s)
- Mark S Johnstone
- Academic Unit of Surgery, School of Medicine, 3526University of Glasgow, Glasgow, UK
| | - Gillian Miller
- Academic Unit of Surgery, School of Medicine, 3526University of Glasgow, Glasgow, UK
| | - Grace Pang
- Academic Unit of Surgery, School of Medicine, 3526University of Glasgow, Glasgow, UK
| | - Paul Burton
- eHealth, Corporate Services, Business Intelligence, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Georgios Kourounis
- Academic Unit of Surgery, School of Medicine, 3526University of Glasgow, Glasgow, UK
| | - Jack Winter
- Department of Gastroenterology, 59736Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Emilia Crighton
- Public Health, Health Service, Public Health Screening, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - David Mansouri
- Department of Coloproctology, 59736Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Paul Witherspoon
- Department of Colorectal Surgery, 427872Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Karen Smith
- Department of Clinical Biochemistry, 59736Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stephen T McSorley
- Academic Unit of Surgery, School of Medicine, 3526University of Glasgow, Glasgow, UK
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11
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Ibáñez-Sanz G, Milà N, Vives N, Vidal C, Binefa G, Rocamora J, Atencia C, Moreno V, Sanz-Pamplona R, Garcia M. Diagnostic Performance of a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program According to Ambient Temperature and Humidity. Cancers (Basel) 2022; 14:cancers14051153. [PMID: 35267461 PMCID: PMC8909312 DOI: 10.3390/cancers14051153] [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] [Received: 12/22/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 02/05/2023] Open
Abstract
Exposure of the fecal immunochemical test (FIT) to different ambient temperatures and humidity is unavoidable in population-based screening programs in Southern European countries, and it could lead to a decrease in target colorectal lesions. The objective was to evaluate the effect of ambient temperature and humidity on the FIT sensitivity in a population-based screening program for colorectal cancer (CRC) using an ecological design. The retrospective cohort included individuals aged 50−69 years who participated in CRC screening (Barcelona) from 2010−2015, and were followed until 2017 to identify interval CRCs. The positivity rate, and detection rates for advanced polyps and CRC were compared according to ambient temperature, humidity, and quarters of the year. A positive FIT was defined as the detection of ≥20 μg Hb/g in feces. The monthly ambient temperature and humidity were recorded on the day that the FIT was performed. In total, 92,273 FIT results from 53,860 participants were analyzed. The FIT positivity rate was lower at >24 °C than at ≤24 °C (p = 0.005) but was not affected by humidity. The temperature’s impact on positivity did not lead to a decrease in the FIT detection rate for advanced neoplasia or the interval cancer detection rate in a program where the samples were refrigerated until the analysis and screening invitations were discontinued in July and August.
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Affiliation(s)
- Gemma Ibáñez-Sanz
- Oncology Data Analytics Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (G.I.-S.); (J.R.); (C.A.); (V.M.); (R.S.-P.)
- Gastroenterology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- Colorectal Cancer Research Group, ONCOBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
| | - Núria Milà
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.V.); (C.V.)
- Early Detection of Cancer Research Group, EPIBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Núria Vives
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.V.); (C.V.)
- Early Detection of Cancer Research Group, EPIBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carmen Vidal
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.V.); (C.V.)
- Early Detection of Cancer Research Group, EPIBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Gemma Binefa
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.V.); (C.V.)
- Early Detection of Cancer Research Group, EPIBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Judith Rocamora
- Oncology Data Analytics Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (G.I.-S.); (J.R.); (C.A.); (V.M.); (R.S.-P.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
| | - Carmen Atencia
- Oncology Data Analytics Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (G.I.-S.); (J.R.); (C.A.); (V.M.); (R.S.-P.)
| | - Víctor Moreno
- Oncology Data Analytics Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (G.I.-S.); (J.R.); (C.A.); (V.M.); (R.S.-P.)
- Colorectal Cancer Research Group, ONCOBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
| | - Rebeca Sanz-Pamplona
- Oncology Data Analytics Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (G.I.-S.); (J.R.); (C.A.); (V.M.); (R.S.-P.)
- Colorectal Cancer Research Group, ONCOBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
| | - Montse Garcia
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.V.); (C.V.)
- Early Detection of Cancer Research Group, EPIBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-60-71-86
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12
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Predictive Modeling of Colonoscopic Findings in a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program. Dig Dis Sci 2022; 67:2842-2848. [PMID: 34350518 PMCID: PMC9237000 DOI: 10.1007/s10620-021-07160-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The fecal immunochemical test (FIT) is the primary modality used by the Los Angeles County Department of Health Services (LADHS) for colorectal cancer (CRC) screening in average-risk patients. Some patients referred for FIT-positive diagnostic colonoscopy have neither adenomas nor more advanced pathology. We aimed to identify predictors of false-positive FIT (FP-FIT) results in our largely disenfranchised, low socioeconomic status population. METHODS We conducted a retrospective study of 596 patients who underwent diagnostic colonoscopy following a positive screening FIT. Colonoscopies showing adenomas (or more advanced pathology) were considered positive. We employed multiple logistic and linear regression as well as machine learning models (MLMs) to identify clinical predictors of FP-FIT (primary outcome) and the presence of advanced adenomas (secondary outcome). RESULTS Overall, 268 patients (45.0%) had a FP-FIT. Female sex and hemorrhoids (odds ratios [ORs] 1.59 and 1.89, respectively) were associated with increased odds of FP-FIT and fewer advanced adenomas (β = - 0.658 and - 0.516, respectively). Conversely, increasing age and BMI (ORs 0.94 and 0.96, respectively) were associated with decreased odds of FP-FIT and a greater number of advanced adenomas (β = 0.073 and 0.041, respectively). MLMs predicted FP-FIT with high specificity (93.8%) and presence of advanced adenoma with high sensitivity (94.4%). CONCLUSION Increasing age and BMI are associated with lower odds of FP-FIT and greater number of advanced adenomas, while female sex and hemorrhoids are associated with higher odds of FP-FIT and fewer advanced adenomas. The presence of the aforementioned predictors may inform the decision to proceed with diagnostic colonoscopy in FIT-positive patients.
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13
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Labaeka EO, Irabor AE, Irabor DO. Fecal Immunochemical Test as a Screening Method for Colorectal Cancer in University College Hospital Ibadan, Nigeria. JCO Glob Oncol 2021; 6:525-531. [PMID: 32216652 PMCID: PMC7113128 DOI: 10.1200/jgo.19.00340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Colorectal cancer (CRC) is a disease of public health importance because of the increasing incidence of the disease and presentation in advanced stage of the disease in Western Africa. CRC is amenable to screening because of the long course of premalignant lesions before final development of the disease. Despite this, the practice of CRC screening is inadequate at the sites in this study. The fecal immunochemical test (FIT) is one of the recommended noninvasive methods for CRC screening. It has a sensitivity of 96%, specificity of 90%, and an overall accuracy of 95%. We aimed to determine the practicability of FIT for CRC screening in patients aged 40 to 75 years who attended primary care clinics in the University College Hospital, Ibadan, Nigeria. PATIENTS AND METHODS A total of 422 patients selected by systematic random sampling were recruited and offered free FIT screening. Participants with a positive finding had additional GI examination, including a digital rectal examination, proctoscopy, and colonoscopy, if no lesion was biopsied during proctoscopy. RESULTS The mean (± standard deviation) age of the respondents was 62 ± 9.61 years. The prevalence of a positive FIT in the study was 10.1%. The FIT was not completed by 3.8% of patients, and the rate of completion of additional evaluation after a positive FIT reduced as the investigations became invasive, with 36.8% and 71.1% noncompletion rates for proctoscopy and colonoscopy, respectively. CONCLUSION A FIT-based screening for age and risk-appropriate patients is practical in this environment, where the capacity and acceptability of colonoscopy are limited.
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Affiliation(s)
- Elizabeth O Labaeka
- Department of Family Medicine University, College Hospital Ibadan, Ibadan, Nigeria
| | - Achiaka E Irabor
- Department of Family Medicine University, College Hospital Ibadan, Ibadan, Nigeria
| | - David O Irabor
- Department of Surgery, Division of Gastrointestinal Surgery, University College Hospital Ibadan, Ibadan, Nigeria
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14
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Young GP, Woodman RJ, Symonds E. Detection of advanced colorectal neoplasia and relative colonoscopy workloads using quantitative faecal immunochemical tests: an observational study exploring the effects of simultaneous adjustment of both sample number and test positivity threshold. BMJ Open Gastroenterol 2021; 7:bmjgast-2020-000517. [PMID: 32994195 PMCID: PMC7526287 DOI: 10.1136/bmjgast-2020-000517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/27/2020] [Accepted: 09/05/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE When screening for colorectal cancer (CRC) using quantitative faecal immunochemical tests (FIT), test parameters requiring consideration are the faecal haemoglobin concentration (f-Hb) positivity cut-off and the number of stools sampled. This observational study explored variation in f-Hb between samples and the relationship between sensitivity for advanced neoplasia (AN, cancer or advanced adenoma) and colonoscopy workload across a range of independently-adjusted parameter combinations. DESIGN Quantitative FIT data (OC-Sensor) were accessed from individuals undergoing personalised colonoscopic screening with an offer of 2-sample FIT in the intervening years. We estimated variation in f-Hb between samples in 12 710 completing 2-sample FIT, plus test positivity rates (colonoscopy workload) and sensitivity for AN according to parameter combinations in 4037 instances where FIT was done in the year preceding colonoscopy. RESULTS There was large within-subject variability between samples, with the ratio for the second to the first sample f-Hb ranging up to 18-fold for all cases, and up to 56-fold for AN cases. Sensitivity for AN was greatest at lower f-Hb cut-offs and/or using 2-sample FIT. Colonoscopy workload varied according to how parameters were combined. Using different cut-offs for 1-sample FIT and 2-sample FIT to return similar sensitivity, workload was less with 2-sample FIT when the sensitivity goal exceeded 35%. CONCLUSION Variation in f-Hb between samples is such that both parameters are crucial determinants of sensitivity and workload; independent adjustment of each should be considered. The 2-sample FIT approach is best for detecting advanced adenomas as well as CRC provided that the colonoscopy workload is feasible.
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Affiliation(s)
- Graeme P Young
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Richard J Woodman
- Biostatistics, Flinders Prevention, Promotion and Primary Health Care, General Practice, Flinders University, Adelaide, South Australia, Australia
| | - Erin Symonds
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
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15
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Clark GRC, Strachan JA, McPherson A, Digby J, Mowat C, Steele RJC, Fraser CG. Faecal haemoglobin distributions by sex, age, deprivation and geographical region: consequences for colorectal cancer screening strategies. Clin Chem Lab Med 2021; 58:2073-2080. [PMID: 32324157 DOI: 10.1515/cclm-2020-0268] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
Objectives Faecal immunochemical tests for haemoglobin (FIT) are becoming widely used in colorectal cancer (CRC) screening and assessment of symptomatic patients. Faecal haemoglobin concentration (f-Hb) thresholds are used to guide subsequent investigation. We established the distributions of f-Hb in a large screening population by sex, age, deprivation and geography. Methods Single estimates of f-Hb were documented for all individuals participating in the first 18 months of the Scottish Bowel Screening Programme (SBoSP). The distributions of f-Hb were generated for all participants, all men and women, and men and women by age quintile and deprivation quintile. Distributions were also generated by geographical region for all participants, men and women, and by deprivation. Comparisons of f-Hb distributions with those found in a pilot evaluation of FIT and three other countries were performed. Results f-Hb was documented for 887,248 screening participants, 422,385 men and 464,863 women. f-Hb varied by sex, age, deprivation quintile and geographical region. The f-Hb distributions by sex and age differed between the SBoSP and the pilot evaluation and the three other countries. Conclusions f-Hb is higher in men than in women and increases with age and deprivation in both sexes. f-Hb also varies by geographical region, independently of deprivation, and by country. The f-Hb distribution estimated by pilot evaluation may not represent the population distribution. Decision limits have advantages over reference intervals. Use of partitioned f-Hb thresholds for further investigation, based on the data generated, has advantages and disadvantages, as do risk scores based on a spectrum of influencing variables.
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Affiliation(s)
- Gavin R C Clark
- Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK.,Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Judith A Strachan
- Department of Blood Sciences and Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Alisson McPherson
- Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Jayne Digby
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Robert J C Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
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16
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Young GP, Chen G, Wilson CJ, McGrane E, Hughes-Barton DLA, Flight IHK, Symonds EL. "Rescue" of Nonparticipants in Colorectal Cancer Screening: A Randomized Controlled Trial of Three Noninvasive Test Options. Cancer Prev Res (Phila) 2021; 14:803-810. [PMID: 34127509 DOI: 10.1158/1940-6207.capr-21-0080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/07/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Few studies have directly targeted nonparticipants in colorectal cancer screening to identify effective engagement strategies. We undertook a randomized controlled trial that targeted nonparticipants in a previous trial of average-risk subjects which compared participation rates for mailed invitations offering a fecal test, a blood test or a choice of either. Nonparticipants (n = 899) were randomized to be offered a kit containing a fecal immunochemical test (FIT), directions on how to arrange a blood DNA test, or the option of doing either. Screening participation was assessed 12 weeks after the offer. To assess the cognitive and attitudinal variables related to participation and invitee choice, invitees were surveyed after 12 weeks, and associations were investigated using multinomial logistic regression. Participation rates were similar between groups (P = 0.88): 12.0% for FIT (35/292), 13.3% for the blood test (39/293), and 13.4% for choice (39/290). Within the choice group, participation was significantly higher with FIT (9.7%, 28/290) compared with the blood test (3.8%, 11/290, P = 0.005). The only variable significantly associated with participation was socioeconomic status when offered FIT, and age when offered choice but there was none when offered the blood test. Survey respondents indicated that convenience, time-saving, comfort, and familiarity were major influences on participation. There was no clear advantage between a fecal test, blood test, or choice of test although, when given a choice, the fecal test was preferred. Differences in variables associated with participation according to invitation strategy warrant consideration when deciding upon an invitation strategy for screening nonparticipants. PREVENTION RELEVANCE: This trial of screening for those at average risk for colorectal cancer targeted past fecal-test nonparticipants and compared participation rates for mailed invitations offering a fecal test, blood test, or choice of either. Although there was no clear advantage between strategies, factors associated with participation differed between each strategy.
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Affiliation(s)
- Graeme Paul Young
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia. .,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caufield East, Victoria, Australia
| | - Carlene J Wilson
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,School of Psychology and Public Health, LaTrobe University, Bundoora, Victoria, Australia
| | - Ellen McGrane
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Donna Lee-Ann Hughes-Barton
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Ingrid Helen K Flight
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Erin Leigh Symonds
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia
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17
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D'Souza N, Georgiou Delisle T, Chen M, Benton S, Abulafi M. Faecal immunochemical test is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms referred on a 2WW pathway: a diagnostic accuracy study. Gut 2021; 70:1130-1138. [PMID: 33087488 PMCID: PMC8108285 DOI: 10.1136/gutjnl-2020-321956] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess whether a faecal immunochemical test (FIT) could be used to select patients with suspected colorectal cancer (CRC) symptoms for urgent investigation. DESIGN Multicentre, double-blinded diagnostic accuracy study in 50 National Health Service (NHS) hospitals across England between October 2017 and December 2019. Patients referred to secondary care with suspected CRC symptoms meeting NHS England criteria for urgent 2 weeks wait referral and triaged to investigation with colonoscopy were invited to perform a quantitative FIT. The sensitivity of FIT for CRC, and effect of relevant variables on its diagnostic accuracy was assessed. RESULTS 9822 patients were included in the final analysis. The prevalence of CRC at colonoscopy was 3.3%. The FIT positivity decreased from 37.2% to 19.0% and 7.6%, respectively, at cut-offs of 2, 10 and 150 µg haemoglobin/g faeces (µg/g). The positive predictive values of FIT for CRC at these cut-offs were 8.7% (95% CI, 7.8% to 9.7%), 16.1% (95% CI 14.4% to 17.8%) and 31.1% (95% CI 27.8% to 34.6%), respectively, and the negative predictive values were 99.8% (95% CI 99.7% to 99.9%), 99.6% (95% CI 99.5% to 99.7%) and 98.9% (95% CI 98.7% to 99.1%), respectively. The sensitivity of FIT for CRC decreased at the same cut-offs from 97.0% (95% CI 94.5% to 98.5%) to 90.9% (95% CI 87.2% to 93.8%) and 70.8% (95% CI 65.6% to 75.7%), respectively, while the specificity increased from 64.9% (95% CI 63.9% to 65.8%) to 83.5% (95% CI 82.8% to 84.3%) and 94.6% (95% CI 94.1% to 95.0%), respectively. The area under the receiver operating characteristic curve was 0.93 (95% CI 0.92 to 0.95). CONCLUSION FIT sensitivity is maximised to 97.0% at the lowest cut-off (2 µg/g); a negative FIT result at this cut-off can effectively rule out CRC and a positive FIT result is better than symptoms to select patients for urgent investigations. TRIAL REGISTRATION NUMBER ISRCTN49676259.
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Affiliation(s)
- Nigel D'Souza
- Colorectal Surgery, Croydon University Hospital, Croydon, UK,Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK,Surgery & Cancer, Imperial College London, London, UK
| | - Theo Georgiou Delisle
- Colorectal Surgery, Croydon University Hospital, Croydon, UK,Surgery & Cancer, Imperial College London, London, UK
| | | | - Sally Benton
- Clinical Biochemistry, Royal Surrey County Hospital, Guildford, UK
| | - Muti Abulafi
- Colorectal Surgery, Croydon University Hospital, Croydon, UK
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18
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Gies A, Niedermaier T, Weigl K, Schrotz-King P, Hoffmeister M, Brenner H. Effect of long-term frozen storage and thawing of stool samples on faecal haemoglobin concentration and diagnostic performance of faecal immunochemical tests. Clin Chem Lab Med 2021; 58:390-398. [PMID: 31655793 DOI: 10.1515/cclm-2019-0878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/09/2019] [Indexed: 12/24/2022]
Abstract
Background Faecal samples collected and stored frozen over years may be a valuable resource for efficient retrospective evaluation of faecal immunochemical tests (FITs). We aimed to assess how prolonged frozen storage and freeze-thaw cycles might affect measures of faecal haemoglobin (Hb) and diagnostic performance of FITs. Methods From 2005 through 2010, participants of screening colonoscopy (n = 2042) and clinical colorectal cancer (CRC) cases (n = 184) provided faecal samples in stool containers (60 mL). The samples were stored at -80 °C for up to 11 years and underwent three freeze-thaw cycles. Between each cycle, a defined amount of faeces was extracted using the manufacturer's sampling device of one or two FITs (RIDASCREEN, OC-Sensor). Faecal Hb concentration and diagnostic performance were calculated and compared across freeze-thaw cycles. Results For RIDASCREEN and the OC-Sensor, repeat measurements were available for 504 and 551 study participants, respectively. Hb concentrations correlated strongly (0.77 and 0.85, respectively) and diagnostic performance indicators were similar at the repeat measurements among the same FITs. For RIDASCREEN we found even slightly higher Hb levels, sensitivities and area under the curves (AUCs) after the third than after the first freeze-thaw cycle. For the OC-Sensor the Hb levels, sensitivities and AUCs were slightly lower after prolonged storage and one additional freeze-thaw cycle. Conclusions Measures of Hb and diagnostic performance were fairly stable, even after long-term frozen storage and multiple freeze-thaw cycles of raw faecal samples. Faecal samples collected in prospective screening studies and kept frozen at -80 °C before analysis seem useful for timely and efficient retrospective evaluation of FIT performance.
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Affiliation(s)
- Anton Gies
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany, Phone: +49-6221-42-3032, Fax: +49-6221-56-5231
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Korbinian Weigl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Petra Schrotz-King
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 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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19
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Symonds EL, Fraser CG, Bastin D, Berwald G, Young GP. The Effect of the Variability in Fecal Immunochemical Test Sample Collection Technique on Clinical Performance. Cancer Epidemiol Biomarkers Prev 2020; 30:175-181. [DOI: 10.1158/1055-9965.epi-20-0984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
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Young GP, Woodman RJ, Ang FLI, Symonds EL. Both Sample Number and Test Positivity Threshold Determine Colonoscopy Efficiency in Detection of Colorectal Cancer With Quantitative Fecal Immunochemical Tests. Gastroenterology 2020; 159:1561-1563.e3. [PMID: 32454037 DOI: 10.1053/j.gastro.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/12/2020] [Accepted: 05/04/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Graeme P Young
- Flinders University, Adelaide, South Australia, Australia.
| | | | - Fang L I Ang
- Flinders University, Adelaide, South Australia, Australia
| | - Erin L Symonds
- Flinders University, Adelaide, South Australia, Australia; Flinders Medical Centre, Bedford Park, South Australia, Australia
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Knapp GC, Alatise OI, Olasehinde OO, Adeyeye A, Ayandipo OO, Weiser MR, Kingham TP. Is Colorectal Cancer Screening Appropriate in Nigeria? J Glob Oncol 2020; 5:1-10. [PMID: 31170018 PMCID: PMC6613663 DOI: 10.1200/jgo.19.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The global burden of colorectal cancer (CRC) will continue to increase for the foreseeable future, largely driven by increasing incidence and mortality in low- and middle-income countries (LMICs) such as Nigeria. METHODS We used the Wilson-Jungner framework (1968) to review the literature relevant to CRC screening in Nigeria and propose areas for future research and investment. RESULTS Screening is effective when the condition sought is both important and treatable within the system under evaluation. The incidence of CRC is likely increasing, although the exact burden of disease in Nigeria remains poorly understood and access to definitive diagnosis and treatment has not been systematically quantified. In high-income countries (HICs), CRC screening builds on a well-known natural history. In Nigeria, a higher proportion of CRC seems to demonstrate microsatellite instability, which is dissimilar to the molecular profile in HICs. Prospective trials, tissue banking, and next-generation sequencing should be leveraged to better understand these potential differences and the implications for screening. Fecal immunochemical test for hemoglobin (FIT) is recommended for LMICs that are considering CRC screening. However, FIT has not been validated in Nigeria, and questions about the impact of high ambient temperature, endemic parasitic infection, and feasibility remain unanswered. Prospective trials are needed to validate the efficacy of stool-based screening, and these trials should consider concomitant ova and parasite testing. CONCLUSION Using the Wilson-Jungner framework, additional work is needed before organized CRC screening will be effective in Nigeria. These deficits can be addressed without missing the window to mitigate the increasing burden of CRC in the medium to long term.
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Knapp GC, Sharma A, Olopade B, Alatise OI, Olasehinde O, Arije OO, Castle PE, Kingham TP. An Exploratory Analysis of Fecal Immunochemical Test Performance for Colorectal Cancer Screening in Nigeria. World J Surg 2020; 43:2674-2680. [PMID: 31407091 DOI: 10.1007/s00268-019-05100-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The fecal immunochemical test (FIT) for hemoglobin is recommended for colorectal cancer (CRC) screening in resource-limited environments. However, there are several unique variables that may alter FIT performance in this setting, including endemic intestinal parasites and high ambient temperature. This prospective study evaluated the performance of FIT in asymptomatic, average-risk individuals of screening age in rural Nigeria. METHODS Three hundred and twenty-four community volunteers completed a questionnaire and provided stool specimens for parasitology and microbiome analysis. Specimens were frozen and stored at -80 °C. Of 324 subjects, 139 met criteria for average-risk CRC screening and had a stool sample for analysis. These were thawed and tested with a qualitative FIT. Specimens positive for occult blood were retested every two days to evaluate the impact of time and temperature on test performance. RESULTS Of 139 individuals, 69 (49.6%) were positive for intestinal parasites and 10 (7.2%) were positive for occult blood. The most common pathogen was Cryptosporidium (40.6%). Among patients with intestinal parasites, 10.1% (7/69) had a positive FIT. Only 4.3% (3/70) of patients without parasites had a positive FIT (p = 0.208). On bivariate analysis, sociodemographic variables were not associated with a positive FIT result. Thirty percent (3/10) of the FIT-positive specimens became FIT-negative with routine storage. CONCLUSION Although a positive FIT result was more common in those with parasitic infection, the relationship was not significant in this small cohort. The impact of high ambient temperature on test positivity may necessitate shorter processing time guidelines for equatorial countries. Additional prospective studies are needed to validate FIT performance in Nigeria.
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Affiliation(s)
- Gregory C Knapp
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-886, New York, NY, 10065, USA.
| | - Avinash Sharma
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-886, New York, NY, 10065, USA
| | - Bolatito Olopade
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusegun I Alatise
- Department of Surgery College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olalekan Olasehinde
- Department of Surgery College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olujide O Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Philip E Castle
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY, USA
| | - T Peter Kingham
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-886, New York, NY, 10065, USA
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23
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Hamarneh Z, Symonds EL, Kholmurodova F, Cock C. Older age, symptoms, or anemia: Which factors increase colorectal cancer risk with a positive fecal immunochemical test? J Gastroenterol Hepatol 2020; 35:1002-1008. [PMID: 31606908 DOI: 10.1111/jgh.14888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Fecal immunochemical tests (FIT) are used to screen asymptomatic individuals aged 50-74 years for colorectal cancer (CRC) within the Australian screening program. Gastrointestinal symptoms or iron deficiency anemia (IDA) may also drive primary care physicians to request a FIT. This study aimed to examine factors that may increase neoplasia risk associated with a positive FIT, specifically age, gastrointestinal symptoms, or IDA. METHODS A retrospective audit was performed on colonoscopies performed in a single hospital in South Australia for a positive FIT (from all referral sources) between 2014 and 2017. Patients aged < 50 years, or who had a colonoscopy in the preceding 5 years, were excluded. A subgroup (n = 198) was evaluated to assess whether age ≥ 75 years, symptoms, or IDA, as well as other demographics, comorbidities, and medications, were associated with risk of neoplasia. Features found to be associated with risk for CRC or high-risk adenoma were examined in the entire cohort using multivariate analysis. RESULTS Colonoscopies (750/4221, 17.8%) were completed in patients ≥ 50 years for a positive FIT. Of these, 7.6% (n = 57) also had gastrointestinal symptoms, 5.5% (n = 41) IDA, and 13.1% (n = 98) were ≥ 75 years. At colonoscopy, 2.8% (n = 21) were diagnosed with CRC and 23.2% (n = 174) with high-risk adenoma. CRC was more prevalent in ≥ 75 years compared with 50-74 years (7.1% vs 2.1%, P = 0.005), and associated with symptoms (15.8% vs 1.7%, P < 0.001), and IDA (14.6% vs 2.1%, P < 0.001). Multivariate analysis showed that IDA (odds ratio 7.68, P < 0.001) and symptoms (odds ratio 10.37, P < 0.001), but not age, were independent risk factors for CRC. CONCLUSION The presence of gastrointestinal symptoms or IDA, independent of age, is associated with an increased risk for CRC following a positive FIT.
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Affiliation(s)
- Zaki Hamarneh
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Erin L Symonds
- Bowel Health Service, Flinders Medical Centre, Adelaide, South Australia, Australia.,Flinders Centre for Innovation in Cancer, Adelaide, South Australia, Australia
| | - Feruza Kholmurodova
- Flinders Centre for Innovation in Cancer, Adelaide, South Australia, Australia.,Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Charles Cock
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
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Mirzaei-Alavijeh M, Schaafsma D, Karami-Matin B, Jalilian F. Socio-cognitive determinants of colorectal cancer screening uptake: An application of intervention mapping approach. Med J Islam Repub Iran 2019; 33:80. [PMID: 31696074 PMCID: PMC6825394 DOI: 10.34171/mjiri.33.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Fecal occult blood test (FOBT) is one of the common screening tests for colorectal cancer. This study was designed to determine the socio-cognitive determinants related to FOBT uptake for colorectal cancer screening based on intervention mapping (IM). Methods: A total of 500 individuals aged over 50 years were randomly selected to participate in this study in Kermanshah, Iran, in 2016. Data were collected by interviews based on a questionnaire and analyzed by SPSS16 using bivariate correlation, linear, and logistic regression models. Results: Of the 500 respondents, 468 (93.6%) signed the consent form and voluntarily participated in the study. Almost 11.1% of the participants had a history of FOBT uptake. Socio-cognitive variables accounted for 38% of the variation in the outcome measure of the intention to uptake FOBT. Perceived self-efficacy (OR = 3.345 & 95% CI: 1.342, 8.339), perceived susceptibility (OR = 2.204& 95% CI: 1.320, 3.680), attitude (OR = 1.674& 95% CI: 1.270, 2.137), and perceived severity (OR = 1.457& 95% CI: 0.954, 2.224) were the strongest predictors of fecal occult blood test uptake. Conclusion: IM-based analysis of behavior may provide insights to design interventions for modifying individuals’ beliefs about the usefulness of FOBT uptake to prevent colorectal cancer.
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Affiliation(s)
- Mehdi Mirzaei-Alavijeh
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dilana Schaafsma
- Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Behzad Karami-Matin
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farzad Jalilian
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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25
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Mowat C, Digby J, Strachan JA, Steele RJC, Fraser CG. Low Sensitivity of Fecal Immunochemical Tests (FIT) for Detection of Sessile Serrated Adenomas/Polyps Confirmed Over Clinical Setting, Geography, and FIT System. Dig Dis Sci 2019; 64:3024-3026. [PMID: 31104198 DOI: 10.1007/s10620-019-05661-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/04/2019] [Indexed: 12/09/2022]
Affiliation(s)
- Craig Mowat
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Jayne Digby
- Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, Scotland, UK
| | - Judith A Strachan
- Department of Blood Sciences and Scottish Bowel Screening Laboratory, NHS Tayside, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Robert J C Steele
- Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, Scotland, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, Scotland, UK.
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Low Sensitivity of Fecal Immunochemical Tests and Blood-Based Markers of DNA Hypermethylation for Detection of Sessile Serrated Adenomas/Polyps. Dig Dis Sci 2019; 64:2555-2562. [PMID: 30835026 DOI: 10.1007/s10620-019-05569-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early detection and removal of precursor lesions reduce colorectal cancer morbidity and mortality. Sessile serrated adenomas/polyps (SSP) are a recognized precursor of cancer, but there are limited studies on whether current screening techniques detect this pathology. AIMS To investigate the sensitivity of fecal immunochemical tests (FIT) and epigenetic biomarkers in blood for detection of SSP. METHODS A prospective study offered FIT and a blood test (Colvera for methylated BCAT1 and IKZF1) to adults referred for colonoscopy. Sensitivity of FIT and the blood test were determined for four types of pathology: low-risk conventional adenoma, high-risk adenoma, SSP, and absence of neoplasia. Comparisons were made for FIT positivity at 10 and 20 μg hemoglobin (Hb)/g feces. RESULTS One thousand eight hundred and eighty-two subjects completed FIT and underwent colonoscopy. One thousand four hundred and three were also tested for methylated BCAT1/IKZF1. The sensitivity of FIT (20 μg Hb/g feces) for SSP was 16.3%. This was lower than the sensitivity for high-risk adenomas (28.7%, p < 0.05), but no different to that for low-risk adenomas (13.1%) or no neoplasia (8.4%). A positive FIT result for SSP was not associated with demographics, morphology, concurrent pathology or intake of medications that increase bleeding risk. FIT sensitivity for SSP did not significantly increase through lowering the positivity threshold to 10 μg Hb/g feces (20.4%, p > 0.05). Sensitivity of the blood test for SSP was 8.8%, and 26.5% when combined with FIT. CONCLUSIONS Both FIT and blood-based markers of DNA hypermethylation have low sensitivity for detection of SSP. Further development of sensitive screening tests is warranted.
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Symonds EL, Hughes D, Flight I, Woodman R, Chen G, Ratcliffe J, Pedersen SK, Fraser RJL, Wilson CJ, Young GP. A Randomized Controlled Trial Testing Provision of Fecal and Blood Test Options on Participation for Colorectal Cancer Screening. Cancer Prev Res (Phila) 2019; 12:631-640. [PMID: 31266825 DOI: 10.1158/1940-6207.capr-19-0089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/24/2019] [Accepted: 06/27/2019] [Indexed: 11/16/2022]
Abstract
Suboptimal participation is commonly observed in colorectal cancer screening programs utilizing fecal tests. This randomized controlled trial tested whether the offer of a blood test as either a "rescue" strategy for fecal test nonparticipants or an upfront choice, could improve participation. A total of 1,800 people (50-74 years) were randomized to control, rescue, or choice groups (n = 600/group). All were mailed a fecal immunochemical test (FIT, OC-Sensor, Eiken Chemical Company) and a survey assessing awareness of the screening tests. The rescue group was offered a blood test 12 weeks after FIT nonparticipation. The choice group was given the opportunity to choose to do a blood test (Colvera, Clinical Genomics) instead of FIT at baseline. Participation with any test after 24 weeks was not significantly different between groups (control, 37.8%; rescue, 36.9%; choice, 33.8%; P > 0.05). When the rescue strategy was offered after 12 weeks, an additional 6.5% participated with the blood test, which was greater than the blood test participation when offered as an upfront choice (1.5%; P < 0.001). Awareness of the tests was greater for FIT than for blood (96.2% vs. 23.1%; P < 0.0001). In a population familiar with FIT screening, provision of a blood test either as a rescue of FIT nonparticipants or as an upfront choice did not increase overall participation. This might reflect a lack of awareness of the blood test for screening compared with FIT.
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Affiliation(s)
- Erin L Symonds
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia. .,Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Donna Hughes
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caulfield East, Victoria, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Health and Social Care Economics Group, Flinders University, Bedford Park, South Australia, Australia
| | | | - Robert J L Fraser
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia.,Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Carlene J Wilson
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia.,School of Psychology & Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia
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Digby J, Steele RJC, Strachan JA, Mowat C, Anderson AS, McCann R, Law L, Fraser CG. Do other variables add value to assessment of the risk of colorectal disease using faecal immunochemical tests for haemoglobin? Ann Clin Biochem 2019; 56:472-479. [DOI: 10.1177/0004563219839423] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Faecal immunochemical tests for haemoglobin have been recommended to assist in assessment of patients presenting in primary care with lower bowel symptoms. The aim was to assess if, and which, additional variables might enhance this use of faecal immunochemical tests. Methods Faecal immunochemical test analysis has been a NHS Tayside investigation since December 2015. During the first year, 993 patients attending colonoscopy were invited to complete a detailed questionnaire on demographic background, symptoms, smoking status, alcohol use, dietary fibre, red and processed meat intake, physical activity, sitting time, dietary supplement use, family history of colorectal cancer, adenoma, inflammatory bowel disease and diabetes. Significant bowel disease was classified as colorectal cancer, advanced adenoma or inflammatory bowel disease. Results A total of 470 (47.3%) invitees agreed to complete the questionnaire and 408 (41.1%) did. Unadjusted odds ratios for the presence of significant bowel disease compared with undetectable faecal haemoglobin increased with increasing faecal haemoglobin and for faecal haemoglobin 10–49, 50–199, 200–399 and ⩾400 μg Hb/g faeces were 0.95 (95% CI: 0.16–5.63), 2.47 (0.55–1.03), 6.30 (1.08–36.65) and 18.90 (4.22–84.62), respectively. Rectal bleeding and family history of polyps were the only other variables with statistically significant ( P < 0.05) odds ratios greater than 1.00, being 1.88 (1.13–3.17) and 2.93 (1.23–6.95), respectively. Odds ratios adjusted for all other variables showed similar associations, but only faecal haemoglobin and family history of polyps had significant associations. Conclusions Faecal haemoglobin is the most important factor to be considered when deciding which patients presenting in primary care with lower bowel symptoms would benefit most from referral for colonoscopy.
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Affiliation(s)
- Jayne Digby
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Robert JC Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Judith A Strachan
- Department of Blood Sciences, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Annie S Anderson
- Centre for Public Health Nutrition, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Rebecca McCann
- Department of Blood Sciences, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Louise Law
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland
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Wong G, Hope RL, Howard K, Chapman JR, Castells A, Roger SD, Bourke MJ, Macaskill P, Turner R, Williams G, Lim WH, Lok CE, Diekmann F, Cross NB, Sen S, Allen RDM, Chadban SJ, Pollock CA, Tong A, Teixeira-Pinto A, Yang JYH, Williams N, Au EHK, Kieu A, James L, Craig JC. One-Time Fecal Immunochemical Screening for Advanced Colorectal Neoplasia in Patients with CKD (DETECT Study). J Am Soc Nephrol 2019; 30:1061-1072. [PMID: 31040191 DOI: 10.1681/asn.2018121232] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/25/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In patients with CKD, the risk of developing colorectal cancer is high and outcomes are poor. Screening using fecal immunochemical testing (FIT) is effective in reducing mortality from colorectal cancer, but performance characteristics of FIT in CKD are unknown. METHODS To determine the detection rates and performance characteristics of FIT for advanced colorectal neoplasia (ACN) in patients with CKD, we used FIT to prospectively screen patients aged 35-74 years with CKD (stages 3-5 CKD, dialysis, and renal transplant) from 11 sites in Australia, New Zealand, Canada, and Spain. All participants received clinical follow-up at 2 years. We used a two-step reference standard approach to estimate disease status. RESULTS Overall, 369 out of 1706 patients who completed FIT (21.6%) tested positive; 323 (87.5%) underwent colonoscopies. A total of 1553 (91.0%) completed follow-up; 82 (4.8%) had died and 71 (4.2%) were lost. The detection rate of ACN using FIT was 6.0% (5.6%, 7.4%, and 5.6% for stages 3-5 CKD, dialysis, and transplant). Sensitivity, specificity, and positive and negative predictive values of FIT for ACN were 0.90, 0.83, 0.30, and 0.99, respectively. Of participants who underwent colonoscopy, five (1.5%) experienced major colonoscopy-related complications, including bowel perforation and major bleeding. CONCLUSIONS FIT appears to be an accurate screening test for patients with CKD, such that a negative test may rule out the diagnosis of colorectal cancer within 2 years. However, the risk of major complications from work-up colonoscopy are at least ten-fold higher than in the general population.
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Affiliation(s)
- Germaine Wong
- Sydney School of Public Health, Faculty of Medicine and Health, .,Centre for Transplant and Renal Research, and.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Richard L Hope
- Department of Gastroenterology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health
| | | | - Antoni Castells
- Gastroenterology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; and.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Spain
| | - Simon D Roger
- Department of Renal Medicine, Gosford Hospital, Gosford, Australia
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Petra Macaskill
- Sydney School of Public Health, Faculty of Medicine and Health
| | - Robin Turner
- Sydney School of Public Health, Faculty of Medicine and Health.,Biostatistics Unit, Dunedin School of Medicine, University of Otago, Christchurch, New Zealand
| | - Gabrielle Williams
- Sydney School of Public Health, Faculty of Medicine and Health.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Wai Hon Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Charmaine E Lok
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplantation, Clinical and Provincial Hospital of Barcelona, Barcelona, Spain
| | - Nicholas B Cross
- Department of Nephrology and Kidney Transplantation, Christchurch Hospital, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Shaundeep Sen
- Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia
| | - Richard D M Allen
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Steven J Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Carol A Pollock
- Department of Medicine, Northern Clinical School, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, Faculty of Medicine and Health.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, Faculty of Medicine and Health.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Narelle Williams
- Sydney School of Public Health, Faculty of Medicine and Health.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Eric Hoi Kit Au
- Sydney School of Public Health, Faculty of Medicine and Health.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Anh Kieu
- Sydney School of Public Health, Faculty of Medicine and Health.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Laura James
- Sydney School of Public Health, Faculty of Medicine and Health.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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30
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de Klerk CM, Wieten E, Lansdorp-Vogelaar I, Bossuyt PM, Spaander MC, Dekker E. Performance of two faecal immunochemical tests for the detection of advanced neoplasia at different positivity thresholds: a cross-sectional study of the Dutch national colorectal cancer screening programme. Lancet Gastroenterol Hepatol 2018; 4:111-118. [PMID: 30497962 DOI: 10.1016/s2468-1253(18)30319-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Faecal immunochemical tests (FITs) are recommended for colorectal cancer screening. Two frequently used FIT methods (FOB-Gold, Sentinel Diagnostics, Milan, Italy and OC-Sensor, Eiken Chemical, Tokyo, Japan) perform similarly in detecting advanced neoplasia (ie, colorectal cancer and advanced adenoma) at a fixed positivity cutoff for faecal haemoglobin concentration. It is unclear whether the performance of the two methods is also comparable at other thresholds. We compared the accuracy of the two assays in detecting advanced neoplasia across various thresholds. METHODS In a cross-sectional study in the Dutch national screening programme, individuals who were screening naive in 2016 (aged 55-75 years) living in the southwest region of the Netherlands were invited to use two different FIT assays on the same bowel movement. Eligible participants were randomly selected from municipal registers. Participants were referred for colonoscopy if either FIT assay result met the predefined positivity threshold (≥15 μg haemoglobin per g faeces). We compared the respective distributions of reported haemoglobin concentration and positivity rates with various FIT positivity thresholds. The performance of each FIT for identifying advanced neoplasia at colonoscopy in FIT-positive assays was compared with the area under the receiver operating characteristic curve. FINDINGS 21 078 (50·0%) of 42 179 invitees completed both FIT assays. The distribution of haemoglobin concentrations differed significantly between the two FITs (p<0·0001), with higher positivity rates for OC-Sensor at FIT thresholds of 5 and 10 μg haemoglobin per g faeces, similar positivity rates at 15 and 20 μg haemoglobin per g faeces, and higher rates for FOB-Gold at FIT thresholds of 25-150 μg haemoglobin per g faeces. 2046 (9·7%) of 21 078 participants had at least one FIT assay that was positive and of these, 1724 (84·3%) attended colonoscopy. The accuracy of results in individuals undergoing colonoscopy did not significantly differ between the FITs, with an area under the receiver operating characteristic curve of 0·675 (95% CI 0·649 to 0·702) for FOB-Gold and 0·686 (0·661 to 0·712) for OC-Sensor (p=0·40). At identical positivity rates, the positive predictive value of the two FIT assays was similar (difference varying from 0·5% [95% CI -2·6 to 3·7] at a positivity rate of 3·5% to 2·4% [-2·5 to 7·3] at a positivity rate of 2·0%). INTERPRETATION The two widely used FITs have significantly different distributions of reported haemoglobin concentration and yield different positivity rates at equal thresholds. However, they perform similarly in detecting advanced neoplasia at a preset positivity rate. When implementing either FIT in a screening programme, the desired positivity rate that identifies participants to be referred for colonoscopy should first be set, guided by available resources and feasibility. FUNDING The Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Clasine M de Klerk
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Els Wieten
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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Participant-Related Risk Factors for False-Positive and False-Negative Fecal Immunochemical Tests in Colorectal Cancer Screening: Systematic Review and Meta-Analysis. Am J Gastroenterol 2018; 113:1778-1787. [PMID: 30158713 PMCID: PMC6768609 DOI: 10.1038/s41395-018-0212-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Colorectal cancer (CRC) screening using fecal immunochemical tests (FIT) may reduce CRC-related mortality but its effectiveness is influenced by the limited accuracy of FIT. Identifying individuals at increased risk of a false FIT result could improve screening, but the available evidence is conflicting. We performed a systematic review and meta-analysis on risk factors for false-positive and false-negative FIT results in CRC screening. METHODS A systematic search in MEDLINE, EMBASE, and Cochrane Library identified publications (before 29 January 2017) on risk factors (known at time of FIT invitation) associated with false FIT results (presence/absence of advanced neoplasia) in a CRC screening setting. Risk of bias was assessed using QUIPS. In meta-analysis, summary relative risk ratios and corresponding 95% confidence intervals were calculated for each risk factor. RESULTS Of 518 records identified, 14 studies with 54,499 participants in total were included for analysis. In meta-analysis, male sex was associated with a significantly lower risk of false-positivity (RR 0.84, CI 0.74-0.94), whereas participants using non-steroidal anti-inflammatory drugs (NSAIDs) had a higher risk (RR 1.16, CI 1.06-1.27). The use of anticoagulants was most frequently studied, without a significant effect on FIT positivity. Males (RR 1.83, CI 1.53-2.19), participants with a family history for CRC (RR 1.61, CI 1.19-2.15), hyperglycemia (RR 1.29, CI 1.02-1.65), hypertension (RR 1.50, CI 1.14-1.98), obesity (RR 1.38, CI 1.11-1.71), and (former) smokers (RR 1.93, CI 1.52-2.45) were all at significantly higher risk for false-negative results. Age was not found to have a systematic effect on either FIT false-positivity or false-negativity in meta-analysis. CONCLUSIONS Multiple risk factors, known at time of FIT invitation, are associated with false FIT results in CRC screening. This information can be used to identify populations risking false reassurance after a negative result or unnecessary colonoscopy after a positive result, and to further optimize CRC screening effectiveness.
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Fraser CG. Faecal immunochemical tests for haemoglobin (FIT) in the assessment of patients with lower abdominal symptoms: current controversies. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:263-270. [PMID: 30459060 DOI: 10.1016/j.gastrohep.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/05/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022]
Abstract
Faecal immunochemical tests for haemoglobin (FIT), as an adjunct to clinical information, assist in the triage of patients presenting in primary care with lower abdominal symptoms. Controversy remains regarding whether and which qualitative and quantitative FIT can be used, which groups of patients would benefit most from FIT, whether FIT should be done in primary and/or secondary care, and how FIT should be incorporated into diagnostic pathways. Controversy also exists as to the optimum cut-off used for referral for colonoscopy. A single sample of faeces may be sufficient. Reporting of results requires consideration. FIT provide a good rule in test for colorectal cancer and a good rule out test for significant bowel disease, but robust safety-netting is required for patients with negative results and ongoing symptoms. Risk scoring models have been developed, but their value is unclear as yet. Further evaluation of these topics is required to inform good 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, Scotland, UK.
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33
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Godber IM, Benton SC, Fraser CG. Setting up a service for a faecal immunochemical test for haemoglobin (FIT): a review of considerations, challenges and constraints. J Clin Pathol 2018; 71:1041-1045. [DOI: 10.1136/jclinpath-2018-205047] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/28/2018] [Accepted: 09/06/2018] [Indexed: 12/16/2022]
Abstract
Quantitative faecal immunochemical tests for haemoglobin (FIT) have now been advocated by the National Institute for Care and Health Excellence (NICE: DG30) to assist in the triage of patients presenting with symptoms that suggest a low risk of colorectal (bowel) cancer. The evidence is that FIT provides a good rule out test for significant bowel disease. However, a small number of cases will be missed, and robust safety-netting procedures are required to follow up some FIT-negative patients. A range of diagnostic pathways are possible, and there is no best approach at present. Introduction of FIT requires careful consideration of the logistics of supply of devices and information to requesting sites and of transport to the laboratory. A number of FIT analytical systems are available. Three are documented as appropriate for use in assessment of patients with symptoms. However, preanalytical, analytical and postanalytical challenges remain. The methods have different specimen collection devices. The methods use polyclonal antibodies and there is no primary reference material or method to which FIT methods are standardised. Third-party internal quality control is lacking, and external quality assessment schemes have many difficulties in providing appropriate materials. Reporting of results should be done using µg Hb/g faeces units and with knowledge of the limit of detection and limit of quantitation of the analytical system used. FIT can be used successfully in an agreed diagnostic pathway, along with other clinical and laboratory information: this requires a multidisciplinary approach, providing opportunities for professionals in laboratory medicine involvement.
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Niedermaier T, Weigl K, Gies A, Hoffmeister M, Brenner H. Accuracy of a fecal immunochemical test according to outside temperature and travel time. Clin Epidemiol 2018; 10:1203-1213. [PMID: 30271216 PMCID: PMC6147538 DOI: 10.2147/clep.s170169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Fecal immunochemical tests (FITs) are widely used and recommended for colorectal cancer (CRC) screening. Fecal hemoglobin (Hb) may degrade with long transport durations and high ambient temperatures, potentially reducing sensitivity to detect CRC and its precursors. This study aimed at investigating the impact of temperatures and sample travel times on diagnostic performance of a quantitative FIT for detection of advanced neoplasms (AN, CRC, or advanced adenoma). Methods Participants of screening colonoscopy in south-western Germany conducted a quantitative FIT prior to bowel preparation between February 2012 and June 2016. From available locations and dates of stool sampling and transport, maximum ambient temperatures were linked to 2,870 participants aged 50–79 years and sample return durations were recorded. The impact of ambient temperatures and return duration on FIT sensitivity and specificity was assessed for five different cutoffs between 10 and 25 µg Hb/g feces. Results At a positivity threshold of 20 µg Hb/g feces, overall sensitivity and specificity for detecting any AN were 40% (95% CI, 35–47%) and 95% (95% CI, 94–96%), respectively. Inverse associations between maximum ambient temperature (median 18.1°C, inter-quartile range [IQR] =11.4–24.9°C) and sensitivity of FIT were observed which were stronger at higher cutoffs. Sample return durations (median 6 days, IQR =4–8 days) were not associated with variable sensitivities or specificities. Conclusion Hb degredation during fecal sample transportation in summer months may be of some concern for diagnostic performance of the FIT evaluated under routine conditions in a middle-European climate.
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Affiliation(s)
- Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany, .,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Korbinian Weigl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany, .,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany,
| | - Anton Gies
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 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, .,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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35
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Nielson CM, Petrik AF, Jacob L, Vollmer WM, Keast EM, Schneider JL, Rivelli JS, Kapka TJ, Meenan RT, Mummadi RR, Green BB, Coronado GD. Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial. Cancer Med 2018; 7:4781-4790. [PMID: 30101513 PMCID: PMC6144161 DOI: 10.1002/cam4.1727] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/06/2018] [Accepted: 07/18/2018] [Indexed: 02/06/2023] Open
Abstract
Annual fecal immunochemical testing (FIT) is cost-effective for colorectal cancer (CRC) screening. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false-positive (FP) results adding to colonoscopy burden without improving cancer detection. Our objective was to describe FIT PPV and the factors associated with FP results among patients undergoing CRC screening. In an ongoing pragmatic clinical trial of mailed-FIT outreach, clinics delivered one of three FIT brands (InSure, OC-Micro, and Hemosure). Patients who had a positive FIT result and a follow-up colonoscopy were included in this analysis (N = 1130). Patients' demographic and medical histories were abstracted from electronic health records (EHR). Associations with a FP result (ie, a positive FIT result with no evidence of advanced neoplasia during follow-up colonoscopy) were evaluated for FIT brand and patient factors using mixed-effects multivariable logistic regression. The mean proportion of FIT-positive results ranged from 8% in centers using the OC-Micro test to 21% for Hemosure. PPVs for advanced neoplasia were 0.30 to 0.17, respectively (P for χ2 = 0.08). In multivariable-adjusted models, use of Hemosure was associated with greater odds of a FP result than OC-Micro (OR = 2.00, 95% CI: 0.47-8.56) or InSure (OR = 1.72, 95% CI: 0.44-6.68). However, only female sex (OR = 1.58, 95% CI: 1.19-2.10) and history of a colorectal condition (OR = 2.17, 95% CI: 1.13-4.15) were significantly associated with FP. In conclusion, FIT positivity varied by brand, and FP results differed by patient factors available through the EHR. These results can be used to minimize the frequency of FP results, reducing patient distress and colonoscopy burden.
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Affiliation(s)
| | | | | | | | - Erin M. Keast
- Kaiser Permanente Center for Health ResearchPortlandOregon
| | | | | | - Tanya J. Kapka
- Kaiser Permanente Center for Health ResearchPortlandOregon
| | | | | | - Beverly B. Green
- Kaiser Permanente Washington Health Research InstituteSeattleWashington
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Rodriguez-Alonso L, Rodriguez-Moranta F, Arajol C, Gilabert P, Serra K, Martin A, Ibáñez-Sanz G, Moreno V, Guardiola J. Proton pump inhibitors reduce the accuracy of faecal immunochemical test for detecting advanced colorectal neoplasia in symptomatic patients. PLoS One 2018; 13:e0203359. [PMID: 30169524 PMCID: PMC6118361 DOI: 10.1371/journal.pone.0203359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 08/20/2018] [Indexed: 02/06/2023] Open
Abstract
Background The faecal immunochemical test (FIT) is used in colorectal cancer (CRC) screening and for the detection of advanced colorectal neoplasia (AN) in symptomatic patients, but its accuracy could be improved. Our objective was to assess the impact of proton pump inhibitors (PPI) on the accuracy of the FIT in the detection of AN, namely advanced colorectal adenoma and CRC. Methods and findings We performed a prospective study of 1002 individuals referred for a diagnostic colonoscopy at Bellvitge University Hospital from September 2011 through to October 2012. An exhaustive interview was performed by a gastroenterologist, prescription drug dispensing database was reviewed and the patient was given a FIT prior to colonoscopy. The positivity threshold of FIT used was ≥ 20 μg Hb/g feces and the main outcome was AN. AN was detected in 13.2% (133) of patients. The accuracy of FIT for detecting AN in the PPI users and non-PPI users were: sensitivity 43.0% vs 65.6%, P = 0.009; specificity 86.9% vs 92.3%, P = 0.010; and, predictive positive value 34.4% vs 55.5%, P = 0.007, respectively. In multivariate analysis, adjusting for potential confounders, PPIs were associated with false positives in AN detection by FIT (OR 1.63 CI 95% 1.02–2.59, P < 0.037). The ROC curve for the FIT in the detection of AN in the PPI users and non-PPI users was 0.68 (CI 95% 0.61–0.76) and 0.85 (CI 95% 0.79–0.90). Conclusions PPI therapy reduces the accuracy of FIT for detecting AN in symptomatic patients.
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Affiliation(s)
- Lorena Rodriguez-Alonso
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Claudia Arajol
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Pau Gilabert
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Katja Serra
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Albert Martin
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Gemma Ibáñez-Sanz
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Catalan Institute of Oncology, Cancer Prevention and Control Programme, IDIBELL, Barcelona, Spain
| | - Victor Moreno
- Catalan Institute of Oncology, Cancer Prevention and Control Programme, IDIBELL, Barcelona, Spain
| | - Jordi Guardiola
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- * E-mail:
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Khashij S, Jalilian F, Vaezi M, Jalilian M, Gharibnavaz H, Ahmadi-Jouybari T, Naghibifar Z, Karami H. Measuring Beliefs Related to Colorectal Cancer Screening Behavior among Iranian Middle-Aged and Elderly: a Psychometric Study. Asian Pac J Cancer Prev 2018; 19:2211-2216. [PMID: 30139227 PMCID: PMC6171398 DOI: 10.22034/apjcp.2018.19.8.2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The annual fecal occult blood test is a very important method for colorectal cancer early detection through screening.
Our aim was to assess psychometrics of instrument measuring beliefs related to fecal occult blood test uptake among
Iranian middle-aged and elderly, based on the theory of planned behavior. This cross-sectional study was performed on
150 middle-aged and elderly who were randomly selected to participate voluntarily in Kermanshah, in the west of Iran.
The studied constructs included attitude, subjective norms, perceived behavior control, and behavior intention. Data
were analyzed with SPSS software (ver. 21.0). The mean age of the respondents was 59.1 years [SD: 6.73], in the range
from 50 to 73. All of the loads of the exploratory factorial analysis were larger than 0.4. KMO was calculated as 0.756.
Overall, four factors under investigation accounted for 82% of the variance in the hypothesized model. Cronbach’s
alpha for the measured constructs of attitude, subjective norms, perceived behavior control, and behavior intention
were 0.92, 0.88, 0.70 and 0.88, respectively. Our findings indicated the final scale to be adequately reliable and valid for
measurement of these constructs for prediction of fecal occult blood test uptake among Iranian middle-aged and elderly.
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Affiliation(s)
- Shiva Khashij
- Clinical Research Development Center, Imam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Direct comparison of ten quantitative fecal immunochemical tests for hemoglobin stability in colorectal cancer screening. Clin Transl Gastroenterol 2018; 9:168. [PMID: 29976921 PMCID: PMC6033915 DOI: 10.1038/s41424-018-0035-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/19/2018] [Accepted: 06/05/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To systematically investigate and directly compare, for the first time, the sample stability of a large number of quantitative fecal immunochemical tests (FITs) at different storage conditions. METHODS Stool samples were obtained from participants of the German screening colonoscopy program between 2005 and 2010. After an initial FIT-based hemoglobin (Hb) measurement, stool samples were kept frozen at -80 °C until analysis. Twenty randomly selected participants with initial measurements ranging from 10 to 100 μg Hb/g feces were included. Ten quantitative FITs were investigated in parallel. A defined stool amount was extracted using each manufacturer's brand-specific fecal sampling device and stored at 5 °C, 20 °C, and 35 °C, respectively. After 1, 4, 5, and 7 days, the samples were analyzed blinded. Median fecal Hb concentrations and positivity rates were calculated. RESULTS Mean age of the participants was 67 years (range: 56-80 years) and 60% were male. The most advanced finding at screening colposcopy was advanced adenoma in five and non-advanced adenoma in eight cases. Hyperplastic polyps were found in two participants and five participants were without any findings. At 5 °C storage temperature, almost all FITs showed fairly stable results throughout the 7-day observation period. At 20 °C, most FITs still showed fairly stable results over 4 days, whereas positivity rates significantly declined from day 4 on for most FITs at 35 °C. Major differences regarding the sample stability between FITs were observed. CONCLUSION FIT-specific Hb decay according to ambient temperature and time period between sampling and test evaluation requires careful consideration in the design of FIT-based screening programs.
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Chen SLS, Hsu CY, Yen AMF, Young GP, Chiu SYH, Fann JCY, Lee YC, Chiu HM, Chiou ST, Chen HH. Demand for Colonoscopy in Colorectal Cancer Screening Using a Quantitative Fecal Immunochemical Test and Age/Sex-Specific Thresholds for Test Positivity. Cancer Epidemiol Biomarkers Prev 2018; 27:704-709. [PMID: 29593012 DOI: 10.1158/1055-9965.epi-17-0387] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/09/2017] [Accepted: 03/23/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Despite age and sex differences in fecal hemoglobin (f-Hb) concentrations, most fecal immunochemical test (FIT) screening programs use population-average cut-points for test positivity. The impact of age/sex-specific threshold on FIT accuracy and colonoscopy demand for colorectal cancer screening are unknown.Methods: Using data from 723,113 participants enrolled in a Taiwanese population-based colorectal cancer screening with single FIT between 2004 and 2009, sensitivity and specificity were estimated for various f-Hb thresholds for test positivity. This included estimates based on a "universal" threshold, receiver-operating-characteristic curve-derived threshold, targeted sensitivity, targeted false-positive rate, and a colonoscopy-capacity-adjusted method integrating colonoscopy workload with and without age/sex adjustments.Results: Optimal age/sex-specific thresholds were found to be equal to or lower than the universal 20 μg Hb/g threshold. For older males, a higher threshold (24 μg Hb/g) was identified using a 5% false-positive rate. Importantly, a nonlinear relationship was observed between sensitivity and colonoscopy workload with workload rising disproportionately to sensitivity at 16 μg Hb/g. At this "colonoscopy-capacity-adjusted" threshold, the test positivity (colonoscopy workload) was 4.67% and sensitivity was 79.5%, compared with a lower 4.0% workload and a lower 78.7% sensitivity using 20 μg Hb/g. When constrained on capacity, age/sex-adjusted estimates were generally lower. However, optimizing age/-sex-adjusted thresholds increased colonoscopy demand across models by 17% or greater compared with a universal threshold.Conclusions: Age/sex-specific thresholds improve FIT accuracy with modest increases in colonoscopy demand.Impact: Colonoscopy-capacity-adjusted and age/sex-specific f-Hb thresholds may be useful in optimizing individual screening programs based on detection accuracy, population characteristics, and clinical capacity. Cancer Epidemiol Biomarkers Prev; 27(6); 704-9. ©2018 AACR.
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Affiliation(s)
- Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Yang Hsu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Australia
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Tao-Yuan, Taiwan.,Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jean Ching-Yuan Fann
- Department of Health Industry Management, School of Healthcare Management, Kainan University, Tao-Yuan, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Ti Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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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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41
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Shapiro JA, Bobo JK, Church TR, Rex DK, Chovnick G, Thompson TD, Zauber AG, Lieberman D, Levin TR, Joseph DA, Nadel MR. A Comparison of Fecal Immunochemical and High-Sensitivity Guaiac Tests for Colorectal Cancer Screening. Am J Gastroenterol 2017; 112:1728-1735. [PMID: 29016558 PMCID: PMC6077997 DOI: 10.1038/ajg.2017.285] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Annual testing using either a high-sensitivity guaiac fecal occult blood test (HS-gFOBT) or a fecal immunochemical test (FIT) is recommended for screening average-risk people for colorectal cancer. We compared the performance characteristics of the HS-gFOBT Hemoccult II SENSA and two FITs (InSure FIT and OC FIT-CHEK) for detecting advanced colorectal neoplasia. METHODS The study included 1,006 asymptomatic patients, aged 50-75 years, who were scheduled to receive a screening colonoscopy at gastroenterology practices in the Minneapolis and Indianapolis metropolitan areas. Each participant was asked to complete all three stool tests before their colonoscopy. Each test's performance characteristics were evaluated using the screening colonoscopic results as the reference standard. RESULTS Sensitivity for detecting advanced colorectal neoplasia was highest for InSure FIT (26.3%, 95% confidence interval (CI) 15.9-40.7), followed by OC FIT-CHEK (15.1%, 95% CI 6.7-26.1) and Hemoccult II SENSA (7.4%, 95% CI 1.9-17.0). InSure FIT was statistically significantly more sensitive than both OC FIT-CHEK (absolute difference in sensitivity=11.2%, 95% CI 0.4-24.2) and Hemoccult II SENSA (difference in sensitivity=18.9%, 95% CI 10.2-32.6). Specificities were relatively high for all tests (between 96.8% and 98.6%). CONCLUSIONS Our results suggest that some FITs are more sensitive than the HS-gFOBT Hemoccult II SENSA, but these results need to be confirmed in larger asymptomatic populations. Comparisons between the FITs examined in this study and other FITs are needed to determine the best tests for population screening.
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Affiliation(s)
- Jean A. Shapiro
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet K. Bobo
- Battelle Health and Analytics, Seattle, Washington, USA
| | - Timothy R. Church
- Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Douglas K. Rex
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Gary Chovnick
- Battelle Health and Analytics, Seattle, Washington, USA
| | - Trevor D. Thompson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ann G. Zauber
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Djenaba A. Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marion R Nadel
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Arana-Arri E, Idigoras I, Uranga B, Pérez R, Irurzun A, Gutiérrez-Ibarluzea I, Fraser CG, Portillo I. Population-based colorectal cancer screening programmes using a faecal immunochemical test: should faecal haemoglobin cut-offs differ by age and sex? BMC Cancer 2017; 17:577. [PMID: 28851318 PMCID: PMC5576224 DOI: 10.1186/s12885-017-3555-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Basque Colorectal Cancer Screening Programme has both high participation rate and high compliance rate of colonoscopy after a positive faecal occult blood test (FIT). Although, colorectal cancer (CRC) screening with biannual (FIT) has shown to reduce CRC mortality, the ultimate effectiveness of the screening programmes depends on the accuracy of FIT and post-FIT colonoscopy, and thus, harms related to false results might not be underestimated. Current CRC screening programmes use a single faecal haemoglobin concentration (f-Hb) cut-off for colonoscopy referral for both sexes and all ages. We aimed to determine optimum f-Hb cut-offs by sex and age without compromising neoplasia detection and interval cancer proportion. METHODS Prospective cohort study using a single-sample faecal immunochemical test (FIT) on 444,582 invited average-risk subjects aged 50-69 years. A result was considered positive at ≥20 μg Hb/g faeces. Outcome measures were analysed by sex and age for a wide range of f-Hb cut-offs. RESULTS We analysed 17,387 positive participants in the programme who underwent colonoscopy. Participation rate was 66.5%. Men had a positivity rate for f-Hb of 8.3% and women 4.8% (p < 0.0001). The detection rate for advanced neoplasia (cancer plus advanced adenoma) was 44.0‰ for men and 15.9‰ for women (p < 0.0001). The number of colonoscopies required decreased in both sexes and all age groups through increasing the f-Hb cut-off. However, the loss in CRC detection increased by up to 28.1% in men and 22.9% in women. CRC missed were generally at early stages (Stage I-II: from 70.2% in men to 66.3% in women). CONCLUSIONS This study provides detailed outcomes in men and women of different ages at a range of f-Hb cut-offs. We found differences in positivity rates, neoplasia detection rate, number needed to screen, and interval cancers in men and women and in younger and older groups. However, there are factors other than sex and age to consider when consideration is given to setting the f-Hb cut-off.
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Affiliation(s)
- Eunate Arana-Arri
- BioCruces Health Research Institute, Plaza Cruces 12, 48903 Barakaldo, Bizkaia Spain
| | - Isabel Idigoras
- Colorectal Cancer Screening Programme Coordination Center, Bilbao, Spain
| | - Begoña Uranga
- Clinical Biochemistry Service, Donostia University Hospital, Basque Health Service, Donostia, Gipuzkoa Spain
| | - Raquel Pérez
- Clinical Biochemistry Service, Cruces University Hospital, Basque Health Service, Barakaldo, Bizkaia Spain
| | - Ana Irurzun
- Clinical Biochemistry Service, Donostia University Hospital, Basque Health Service, Donostia, Gipuzkoa Spain
| | | | - Callum G. Fraser
- Centre for Research into Cancer Prevention & Screening, University of Dundee, Dundee, Scotland
| | - Isabel Portillo
- Centre for Research into Cancer Prevention & Screening, University of Dundee, Dundee, Scotland
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Buron A, Auge JM, Sala M, Román M, Castells A, Macià F, Comas M, Guiriguet C, Bessa X, Castells X. Association between socioeconomic deprivation and colorectal cancer screening outcomes: Low uptake rates among the most and least deprived people. PLoS One 2017. [PMID: 28622365 PMCID: PMC5473580 DOI: 10.1371/journal.pone.0179864] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Screening with faecal occult blood tests reduces colorectal cancer-related mortality; however, age, sex and socioeconomic factors affect screening outcomes and could lead to unequal mortality benefits. The aim of this study was to describe the main outcomes of the population-based Barcelona colorectal cancer screening programme (BCRCSP) by deprivation. Methods Retrospective study of the eligible population of the first round of the BCRCSP. Participants’ postal addresses were linked with the MEDEA database to obtain the deprivation quintiles (Dq). Chi-squared tests were used to compare proportions across variables and logistic regression was used to estimate the adjusted effects of age, sex and deprivation on uptake, FIT positivity, colonoscopy adherence and advanced neoplasia detection rate. Results Overall uptake was 44.7%, higher in Dq2, 3 and 4 (OR 1.251, 1.250 and 1.276, respectively) than in the least deprived quintile (Dq 1), and lowest in Dq5 (OR 0.84). Faecal immunochemical test (FIT) positivity and the percentage of people with detectable faecal haemoglobin below the positivity threshold increased with deprivation. The advanced neoplasia detection rate was highest in Dq4. Conclusion Unlike most regions where inequalities are graded along the socioeconomic continuum, inequalities in the uptake of colorectal cancer screening in Spain seem to be concentrated first in the most disadvantaged group and second in the least deprived group. The correlation of deprivation with FIT-positivity and faecal haemoglobin below the positivity threshold is worrying due to its association with colorectal cancer and overall mortality.
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Affiliation(s)
- 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
- * E-mail:
| | - Josep M. Auge
- Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
- IDIBAPS (August Pi i Sunyer Biomedical Research Institute), Barcelona, Spain
| | - Maria Sala
- 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
| | - Marta Román
- 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
| | - Antoni Castells
- IDIBAPS (August Pi i Sunyer Biomedical Research Institute), Barcelona, Spain
- Gastroenterology Department, Hospital Clínic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERehd (CIBER for Digestive and Liver Diseases), Madrid, Spain
| | - Francesc Macià
- 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
| | - Mercè Comas
- 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
| | - Carolina Guiriguet
- Gòtic Primary Care Center, Catalan Institute of Health, Barcelona, Spain
- IDIAP Jordi Gol (Institute in Primary Care Research), Barcelona, Spain
| | - Xavier Bessa
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Xavier Castells
- 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
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Guaiac faecal occult blood screening in individuals younger than 50 years of age. Eur J Cancer Prev 2017; 26:189-194. [DOI: 10.1097/cej.0000000000000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Toes-Zoutendijk E, van Leerdam ME, Dekker E, van Hees F, Penning C, Nagtegaal I, van der Meulen MP, van Vuuren AJ, Kuipers EJ, Bonfrer JMG, Biermann K, Thomeer MGJ, van Veldhuizen H, Kroep S, van Ballegooijen M, Meijer GA, de Koning HJ, Spaander MCW, Lansdorp-Vogelaar I. Real-Time Monitoring of Results During First Year of Dutch Colorectal Cancer Screening Program and Optimization by Altering Fecal Immunochemical Test Cut-Off Levels. Gastroenterology 2017; 152:767-775.e2. [PMID: 27890769 DOI: 10.1053/j.gastro.2016.11.022] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/12/2016] [Accepted: 11/16/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS After careful pilot studies and planning, the national screening program for colorectal cancer (CRC), with biennial fecal immunochemical tests (FITs), was initiated in The Netherlands in 2014. A national information system for real-time monitoring was developed to allow for timely evaluation. Data were collected from the first year of this screening program to determine the importance of planning and monitoring for optimal screening program performance. METHODS The national information system of the CRC screening program kept track of the number of invitations sent in 2014, FIT kits returned, and colonoscopies performed. Age-adjusted rates of participation, the number of positive test results, and positive predictive values (PPVs) for advanced neoplasia were determined weekly, quarterly, and yearly. RESULTS In 2014, there were 741,914 persons invited for FIT; of these, 529,056 (71.3%; 95% CI, 71.2%-71.4%) participated. A few months into the program, real-time monitoring showed that rates of participation and positive test results (10.6%; 95% CI, 10.5%-10.8%) were higher than predicted and the PPV was lower (42.1%; 95% CI, 41.3%-42.9%) than predicted based on pilot studies. To reduce the burden of unnecessary colonoscopies and alleviate colonoscopy capacity, the cut-off level for a positive FIT result was increased from 15 to 47 μg Hb/g feces halfway through 2014. This adjustment decreased the percentage of positive test results to 6.7% (95% CI, 6.6%-6.8%) and increased the PPV to 49.1% (95% CI, 48.3%-49.9%). In total, the first year of the Dutch screening program resulted in the detection of 2483 cancers and 12,030 advanced adenomas. CONCLUSIONS Close monitoring of the implementation of the Dutch national CRC screening program allowed for instant adjustment of the FIT cut-off levels to optimize program performance.
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Affiliation(s)
- Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Frank van Hees
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corine Penning
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Iris Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Miriam P van der Meulen
- Department of Public Health, 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
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Johannes M G Bonfrer
- Department of Clinical Chemistry, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Katharina Biermann
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten G J Thomeer
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harriët van Veldhuizen
- Department of Quality Improvement, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sonja Kroep
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Gerrit A Meijer
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Symonds EL, Cole SR, Bastin D, Fraser RJL, Young GP. Effect of sample storage temperature and buffer formulation on faecal immunochemical test haemoglobin measurements. J Med Screen 2017; 24:176-181. [DOI: 10.1177/0969141316686808] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives Faecal immunochemical test accuracy may be adversely affected when samples are exposed to high temperatures. This study evaluated the effect of two sample collection buffer formulations (OC-Sensor, Eiken) and storage temperatures on faecal haemoglobin readings. Methods Faecal immunochemical test samples returned in a screening programme and with ≥10 µg Hb/g faeces in either the original or new formulation haemoglobin stabilizing buffer were stored in the freezer, refrigerator, or at room temperature (22℃–24℃), and reanalysed after 1–14 days. Samples in the new buffer were also reanalysed after storage at 35℃ and 50℃. Results were expressed as percentage of the initial concentration, and the number of days that levels were maintained to at least 80% was calculated. Results Haemoglobin concentrations were maintained above 80% of their initial concentration with both freezer and refrigerator storage, regardless of buffer formulation or storage duration. Stability at room temperature was significantly better in the new buffer, with haemoglobin remaining above 80% for 20 days compared with six days in the original buffer. Storage at 35℃ or 50℃ in the new buffer maintained haemoglobin above 80% for eight and two days, respectively. Conclusion The new formulation buffer has enhanced haemoglobin stabilizing properties when samples are exposed to temperatures greater than 22℃.
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Affiliation(s)
- Erin L Symonds
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia
- Bowel Health Service, Repatriation General Hospital, Daw Park, SA, Australia
| | - Stephen R Cole
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia
- Bowel Health Service, Repatriation General Hospital, Daw Park, SA, Australia
| | - Dawn Bastin
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia
- Bowel Health Service, Repatriation General Hospital, Daw Park, SA, Australia
| | - Robert JL Fraser
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia
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Cooper JA, Moss SM, Smith S, Seaman HE, Taylor-Phillips S, Parsons N, Halloran SP. FIT for the future: a case for risk-based colorectal cancer screening using the faecal immunochemical test. Colorectal Dis 2016; 18:650-3. [PMID: 27135192 DOI: 10.1111/codi.13365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/09/2016] [Indexed: 12/12/2022]
Abstract
Worldwide, the guaiac faecal occult blood test (gFOBT) is being replaced with the more accurate faecal immunochemical test (FIT) for colorectal cancer (CRC) screening. From January 2016, the National Screening Committee in the UK has recommended a change from the gFOBT to the FIT following a successful Bowel Cancer Screening Programme pilot study with over 40 000 participants. Although the test has shown improved uptake and the ability to detect significantly more colorectal cancers and advanced adenomas, the higher uptake and test positivity will challenge the capacity of colonoscopy services. One of the main advantages of the FIT is that it provides a quantitative haemoglobin concentration which has been shown to relate to the risk of CRC. Risk scoring systems which combine the FIT concentration with risk factor assessment have been shown to improve the sensitivity of the test. This individualized approach to screening could enable those at greatest risk to be referred for colonoscopy, optimizing resource use and ultimately patient outcomes.
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Affiliation(s)
- J A Cooper
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
| | - S M Moss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - S Smith
- Midlands and North West Bowel Cancer Screening Hub, Hospital of St Cross, University Hospitals Coventry and Warwickshire NHS Trust, Rugby, UK
| | - H E Seaman
- Surrey Research Park, NHS Bowel Cancer Screening Southern Programme Hub, Guildford, Surrey, UK
| | - S Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - N Parsons
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - S P Halloran
- Department of Biochemistry and Physiology, University of Surrey, Guildford, Surrey, UK
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Baxter NT, Ruffin MT, Rogers MAM, Schloss PD. Microbiota-based model improves the sensitivity of fecal immunochemical test for detecting colonic lesions. Genome Med 2016; 8:37. [PMID: 27056827 PMCID: PMC4823848 DOI: 10.1186/s13073-016-0290-3] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/16/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second leading cause of death among cancers in the United States. Although individuals diagnosed early have a greater than 90% chance of survival, more than one-third of individuals do not adhere to screening recommendations partly because the standard diagnostics, colonoscopy and sigmoidoscopy, are expensive and invasive. Thus, there is a great need to improve the sensitivity of non-invasive tests to detect early stage cancers and adenomas. Numerous studies have identified shifts in the composition of the gut microbiota associated with the progression of CRC, suggesting that the gut microbiota may represent a reservoir of biomarkers that would complement existing non-invasive methods such as the widely used fecal immunochemical test (FIT). METHODS We sequenced the 16S rRNA genes from the stool samples of 490 patients. We used the relative abundances of the bacterial populations within each sample to develop a random forest classification model that detects colonic lesions using the relative abundance of gut microbiota and the concentration of hemoglobin in stool. RESULTS The microbiota-based random forest model detected 91.7% of cancers and 45.5% of adenomas while FIT alone detected 75.0% and 15.7%, respectively. Of the colonic lesions missed by FIT, the model detected 70.0% of cancers and 37.7% of adenomas. We confirmed known associations of Porphyromonas assaccharolytica, Peptostreptococcus stomatis, Parvimonas micra, and Fusobacterium nucleatum with CRC. Yet, we found that the loss of potentially beneficial organisms, such as members of the Lachnospiraceae, was more predictive for identifying patients with adenomas when used in combination with FIT. CONCLUSIONS These findings demonstrate the potential for microbiota analysis to complement existing screening methods to improve detection of colonic lesions.
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Affiliation(s)
- Nielson T. Baxter
- />Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI USA
| | - Mack T. Ruffin
- />Department of Family Medicine, University of Michigan, Ann Arbor, MI USA
| | - Mary A. M. Rogers
- />Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Patrick D. Schloss
- />Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI USA
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Chiu HM, Ching JYL, Wu KC, Rerknimitr R, Li J, Wu DC, Goh KL, Matsuda T, Kim HS, Leong R, Yeoh KG, Chong VH, Sollano JD, Ahmed F, Menon J, Sung JJY. A Risk-Scoring System Combined With a Fecal Immunochemical Test Is Effective in Screening High-Risk Subjects for Early Colonoscopy to Detect Advanced Colorectal Neoplasms. Gastroenterology 2016; 150:617-625.e3. [PMID: 26627608 DOI: 10.1053/j.gastro.2015.11.042] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/15/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Age, sex, smoking, and family history are risk factors for colorectal cancer in Asia. The Asia-Pacific Colorectal Screening (APCS) scoring system was developed to identify subjects with a high risk for advanced neoplasm (AN). We tested an algorithm that combined APCS scores with fecal immunochemical test (FIT) in colorectal cancer screening. METHODS We performed a multicenter prospective study, enrolling asymptomatic individuals older than 40 years old in 12 Asia-Pacific regions from December 2011 to December 2013. APCS scores were calculated for each individual (0-1 = low risk [LR], 2-3 = medium risk [MR], and 4-7 = high risk [HR] for AN). LR and MR subjects were offered FIT and referred for early colonoscopies if FIT results were positive. HR subjects were offered colonoscopies. The proportions of subjects with ANs were determined for each group based on colonoscopy findings; odd ratios for LR and MR subjects were calculated compared to LR individuals. We calculated the sensitivity of the APCS-FIT algorithm in identifying subjects with AN. RESULTS A total of 5657 subjects were recruited: 646 subjects (11.4%) were considered LR, 3243 subjects (57.3%) were considered MR, and 1768 subjects (31.3%) were considered HR for AN. The proportions of individuals with an AN in these groups were 1.5%, 5.1%, and 10.9%, respectively. Compared with LR group, MR and HR subjects had a 3.4-fold increase and a 7.8-fold increase in risk for AN, respectively. A total of 70.6% subjects with AN (95% confidence interval: 65.6%-75.1%) and 95.1% subjects with invasive cancers (95% confidence interval: 82.2%-99.2%) were correctly instructed to undergo early colonoscopy examination. CONCLUSIONS The APCS scoring system, which is based on age, sex, family history, and smoking, is a useful tool for determining risk for colorectal cancer and advanced adenoma in asymptomatic subjects. Use of the APCS score-based algorithm in triaging subjects for FIT or colonoscopy can substantially reduce colonoscopy workload.
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Affiliation(s)
- Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jessica Y L Ching
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, New Territory, Hong Kong
| | - Kai Chun Wu
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jingnan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Deng-Chiang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Khean Lee Goh
- Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hyun-Soo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Rupert Leong
- Bankstown and Concord Hospitals, Sydney, New South Wales, Australia
| | - Khay Guan Yeoh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vui Heng Chong
- Division of Gastroenterology, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Brunei Darussalam
| | - Jose D Sollano
- Section of Gastroenterology, University of Santo Tomas Hospital, Manila, Philippines
| | - Furqaan Ahmed
- Division of Gastroenterology, Aga Khan University, Karachi, Pakistan
| | - Jayaram Menon
- Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Joseph J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, New Territory, Hong Kong.
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