Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

Frontiers in Medicine

article

Rocío Aznar-Gimeno¹  Patricia Carrera-Lasfuentes²  Rafael del-Hoyo-Alonso¹  Manuel Doblaré⁴  Ángel Lanas² 

[1] Department of Big Data and Cognitive Systems, Instituto Tecnológico de Aragón;Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd);Aragón Health Research Institute (IIS Aragón);Aragón Institute of Engineering Research (I3A);Department of Mechanical Engineering, University of Zaragoza;Biomedical Research Networking Center in Bioengineering;Department of Medicine, University of Zaragoza;University Clinic Hospital

关键词: colorectal cancer;    screening fecal-immunological test;    decision-making;    colonoscopy;    adenomas;   

DOI  :  10.3389/fmed.2021.712040

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs. Resuming these programs is a priority, but fewer colonoscopies may be available. We developed an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC. Methods: We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/2018. We investigated two different scenarios: not modifying vs. modifying the FIT cut-off value. We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed). Results: The current FIT cut-off (20-μg hemoglobin/g feces) led to 6,606 colonoscopies per 100,000 people invited annually. Without modifying this FIT cut-off value, when the optimal number of individuals invited for colonoscopies was reduced by 10–40%, a high number of CRCs and high-risk adenomas (34–135 and 73–288/100.000-people invited, respectively) will be undetected every year. When the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability, the number of missed lesions per year was remarkably reduced (9–36 and 29–145/100.000 people, respectively). Moreover, the unmodified FIT scenario outcome was improved by prioritizing the selection process based on sex (males) and age, rather than randomly reducing the number invited. Conclusions: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors to prioritize access to colonoscopies should be also considered.

【 授权许可】

CC BY