TY - JOUR
T1 - Participant-Related Risk Factors for False-Positive and False-Negative Fecal Immunochemical Tests in Colorectal Cancer Screening: Systematic Review and Meta-Analysis
AU - de Klerk, Clasine M.
AU - Vendrig, Lisanne M.
AU - Bossuyt, Patrick M.
AU - Dekker, Evelien
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85053309623&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30158713
U2 - https://doi.org/10.1038/s41395-018-0212-7
DO - https://doi.org/10.1038/s41395-018-0212-7
M3 - Article
C2 - 30158713
SN - 0002-9270
VL - 113
SP - 1778
EP - 1787
JO - American journal of gastroenterology
JF - American journal of gastroenterology
IS - 12
ER -