Population-based colorectal cancer screening programmes using a faecal immunochemical test: should faecal haemoglobin cut-offs differ by age and sex?

BMC Cancer

Research Article

Eunate Arana-Arri¹  Isabel Portillo²  Callum G. Fraser²  Raquel Pérez³  Begoña Uranga⁴  Ana Irurzun⁴  Isabel Idigoras⁵  Iñaki Gutiérrez-Ibarluzea⁶ 

[1]BioCruces Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain

[2]Centre for Research into Cancer Prevention & Screening, University of Dundee, Dundee, Scotland

[3]Clinical Biochemistry Service, Cruces University Hospital, Basque Health Service, Barakaldo, Bizkaia, Spain

[4]Clinical Biochemistry Service, Donostia University Hospital, Basque Health Service, Donostia, Gipuzkoa, Spain

[5]Colorectal Cancer Screening Programme Coordination Center, Bilbao, Spain

[6]Osteba, Basque Office for Health Technology Assessment, Ministry for Health, Vitoria-Gasteiz, Spain

关键词: Adenoma;    Colorectal cancer;    Faecal immunochemical test;    Faecal occult blood test;    Interval cancers;    Screening;   

DOI  :  10.1186/s12885-017-3555-3

 received in 2017-03-27, accepted in 2017-08-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsProspective 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.ResultsWe 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).ConclusionsThis 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.

【 授权许可】

CC BY   
© The Author(s). 2017