Comparison with first round findings of faecal haemoglobin concentrations and clinical outcomes in the second round of a biennial faecal immunochemical test based colorectal cancer screening programme

Abstract

Objective How faecal haemoglobin concentrations (f-Hb) vary from one round to the next in a colorectal cancer (CRC) screening programme, and relate to colonoscopy findings, are unknown. Our aim was to use data from the first two rounds of the faecal immunochemical test (FIT) based Scottish Bowel Screening Programme (SBoSP) to explore these issues. Methods Faecal haemoglobin concentration (f-Hb) percentiles in the second round were compared with those in the first when the first round yielded a negative FIT result (<80 µg Hb/g faeces), a positive FIT but no colonoscopy, CRC, all adenoma, and a negative colonoscopy. In addition, the outcomes in the first and second rounds were compared. Results The profiles of f-Hb in the first and second rounds differed in (a) those who had had a negative FIT result in the first round and (b) those in whom neoplastic pathology had been found. In contrast, the pattern of difference between profiles in those who had had a negative colonoscopy was very similar to that in those in whom an adenoma had been found. In addition, the risk of CRC being diagnosed in the second round after a negative colonoscopy in the first was 3.0%, not very different to that after a negative test result (4.9%). Conclusions Adenomas may be rarely the cause of a positive FIT result. An alternative explanation as to why these are detected using FIT is required. In addition, a negative colonoscopy for a positive FIT result does not rule out the finding of significant neoplastic pathology in the next round.

Adherence to follow-up and resource use after abnormal FIT-screening: Evaluation of the Danish colorectal cancer screening program

“…We found that 22% of patients with low-risk assessments at baseline colposcopy had a colonoscopy despite it not being recommended for surveillance. Although this may signal overuse of diagnostic services, we should contrast it with the recent finding that only 72% of these individuals attended for subse-quent screening [30], with a potentially high persistent FIT test positivity rate at that screen [31]. We do not have data to describe the overlap between those with unexpected colonoscopies and those with positive tests at the next screen.…”

Colorectal cancer screening future modalities among Saudi population: national questioner

“…A different reason is needed for how these are discovered by FAIT. Furthermore, a normal endoscopy for a positive FAIT exam does not preclude the discovery of severe tumour formation in the subsequent round (17).…”