Abstract
BACKGROUND: Faecal immunochemical testing (FIT) for colorectal cancer (CRC) screening has suboptimal sensitivity for detecting advanced neoplasia. To increase its performance, FIT could be combined with other risk factors.
AIM: To evaluate the incremental yield of a screening programme using a positive FIT or a CRC family history, to offer a diagnostic colonoscopy.
METHODS: For this post hoc analysis, data were collected in the colonoscopy arm of a colonoscopy or colonography for screening study. In this study, 6600 randomly selected, asymptomatic men and women (50-75 years) were invited for screening colonoscopy. 1112 Participants completed a FIT and a questionnaire prior to colonoscopy. We compared the yield of FIT-only and FIT combined with CRC family history, defined as having one or more first-degree relatives with CRC.
RESULTS: At a 10 μg Hb/g faeces FIT-positivity threshold the combined strategy would increase the yield from 36 (3.2%; CI: 2.4-4.5%) to 53 (4.8%; CI: 3.7-6.2%) cases of advanced neoplasia, at the expense of 148 additional negative colonoscopies. Sensitivity in detecting advanced neoplasia would increase from 36% (CI: 26-46%) to 52% (CI: 42-63%), whereas specificity would decrease from 93% (CI: 92-95%) to 79% (CI: 76-81%). The strategy will be preferred if one accepts 8.8 false positives for every additional participant in whom advanced neoplasia can be detected.
CONCLUSIONS: Offering colonoscopy to those with a positive FIT or CRC family history increases the yield of a FIT-based screening programme. Depending on the number of negative colonoscopies one accepts, this combined approach can be considered for improving CRC screening.
Original language | English |
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Pages (from-to) | 88-96 |
Number of pages | 9 |
Journal | Alimentary Pharmacology and Therapeutics |
Volume | 44 |
Issue number | 1 |
DOIs | |
Publication status | Published - Jul 2016 |
Keywords
- Aged
- Colonoscopy/methods
- Colorectal Neoplasms/diagnosis
- Early Detection of Cancer/methods
- Feces
- Female
- Humans
- Male
- Mass Screening/methods
- Middle Aged
- Occult Blood
- Risk Factors
- Sensitivity and Specificity
- Surveys and Questionnaires