Demand for Colonoscopy in Colorectal Cancer Screening Using a Quantitative Fecal Immunochemical Test and Age/Sex-Specific Thresholds for Test Positivity

Chen, Sam Li Sheng; Hsu, Chen Yang; Yen, Amy Ming Fang; Young, Graeme P.; Chiu, Sherry Yueh Hsia; Fann, Jean Ching Yuan; Lee, Yi–Chia; Chiu, Han–Mo; Chiou, Shu Ti; Chen, Chien-Jen

doi:10.1158/1055-9965.epi-17-0387

Cited by 14 publications

(15 citation statements)

References 19 publications

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“…Three studies with 1,459,185 participants provided results stratified by sex. 9,15,56 Pooled sensitivity by sex was 77% (95% CI, 75%-79%) in men and 81% (95% CI, 60%-100%) in women (Figure 2; P ¼ .68), with high heterogeneity (overall I 2 ¼ 99%). Specificity was 92% (95% CI, 89%-95%) and 94% (95% CI, 91%-97%), respectively (P ¼ .28).…”

Section: Stratification Of Studies With Colonoscopy Follow-up By Posimentioning

confidence: 99%

“…Specificity was 92% (95% CI, 89%-95%) and 94% (95% CI, 91%-97%), respectively (P ¼ .28). Four studies with 1,393,499 participants stratified by age 9,15,46,56 ; pooled sensitivity for 3 studies was 85% for ages 50-59 years (95% CI, 71%-99%) and 73% for ages 60-69 years (95% CI, 71%-75%; P ¼ .10), with high heterogeneity (overall I 2 ¼ 80%). 9,15,56 Specificity was 94% (95% CI, 92%-97%) and 93% (95% CI, 90%-96%), respectively (P ¼ .…”

Section: Stratification Of Studies With Colonoscopy Follow-up By Posimentioning

confidence: 99%

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Effect of Sex, Age, and Positivity Threshold on Fecal Immunochemical Test Accuracy: A Systematic Review and Meta-analysis

et al. 2019

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Section: Stratification Of Studies With Colonoscopy Follow-up By Posimentioning

confidence: 99%

Section: Stratification Of Studies With Colonoscopy Follow-up By Posimentioning

confidence: 99%

Effect of Sex, Age, and Positivity Threshold on Fecal Immunochemical Test Accuracy: A Systematic Review and Meta-analysis

et al. 2019

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“…Between 645 and 2005 CRC cases were identified through screening program records and cancer registry-based follow-up over one or two years from participation in FIT based screening. [10][11][12][13] Together these studies included almost 5,000 CRC cases. All four studies reported sensitivity and specificity for a FIT cutoff at 20 µg hemoglobin per g feces.…”

Section: Discussionmentioning

confidence: 99%

“…2 In recent years, very large studies using the indirect approach have been published from established FIT-based screening programs, which in sum included almost 5000 CRC cases, so that evidence for FIT sensitivity now predominantly comes from those studies. [10][11][12][13] The indirect approach relies on two key assumptions, i.e. that (i) all CRC cases detected within 2 years derive from preclinical CRCs that are already present at the time of FIT screening, and…”

Section: Introductionmentioning

confidence: 99%

Overestimated Sensitivity of Fecal Immunochemical Tests in Screening Cohorts With Registry-Based Follow-up

2019

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Objectives. Several recent studies have reported very high estimates of sensitivity and specificity of fecal immunochemical tests (FITs) at seemingly high levels of precision using registry-based follow-up of participants in very large FIT-based screening programs.We aimed to assess the validity of estimates of diagnostic performance parameters derived by this indirect approach.Methods. We modeled expected values of sensitivity and specificity of CRC detection in studies using the indirect approach and their deviation from true values under a broad range of plausible assumptions, and we compared these expected values with recently reported estimates of FIT sensitivity and specificity from such studies.Results. Using a sensitivity of 75% and specificity of 93.6% (from studies using a direct approach, i.e., colonoscopy follow-up of all participants), the indirect approach would be expected to yield sensitivities between 84.5% and 91.1% and specificities between 93.4% and 93.6% under a range of realistic assumptions regarding colonoscopic follow-up rates of positive FITs and clinical manifestation rates of preclinical CRC.Conclusions. Very high sensitivities of FITs recently reported with seemingly very high levels of precision by several large scale registry-based studies, which are in line with expected results based on our model calculations, are likely to be strongly overestimated and need to be interpreted with due caution.

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“…Tailored screening adjusting FIT cutoff based on age and gender may reduce colonoscopy demand without compromising the detection of advanced neoplasms and seems a feasible approach [29].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Risk of colonoscopy-related complications in a fecal immunochemical test-based population colorectal cancer screening program

Hsu

Chang

et al. 2020

Endoscopy

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Background and study aims: The likelihood of advanced or synchronous neoplasms is significantly higher in fecal immunochemical test (FIT)-positive subjects than in the general population. The magnitude of colonoscopy-related complication rate in FIT-positive subjects, however, remains unknown. This study aims to elucidate the colonoscopy-related complication rate after positive FIT and compared with colonoscopy performed for other purposes. Patients and methods: Information regarding colonoscopy after positive FIT (FIT-colonoscopy) and ordinary colonoscopy related severe complications during 2010-2014 was ascertained from the Taiwanese Colorectal Cancer (CRC) Screening Program Database and National Health Insurance Research Database (NHIRD). Severe complications included significant bleeding, perforation, and cardiopulmonary events <14 days of colonoscopy. The number of events per 1000 procedures was used to quantify complication rates. Multivariate analysis was conducted to assess the association of various factors with severe complications in comparison with ordinary colonoscopy. Results: A total of 319,114 FIT-colonoscopies (214,955 subjects) were identified. Of those, 51,242 (16.1%) underwent biopsy and 94,172 (29.5%) underwent polypectomy; 2,125 had significant bleeding (6.7‰) and 277 had perforation (0.9‰) <14 days after colonoscopy. Polypectomy, antiplatelet use, and anticoagulant use were associated with higher risk of complications [adjusted odds ratio (aOR)= 4.41 (95% Confidence Interval {CI}=4.05–4.81); 1.35 (95%CI=1.12–1.53); and 1.88 (95%CI=0.61–5.84), respectively]. Compared with ordinary colonoscopy, FIT-colonoscopy involved significantly higher risk of significant bleeding [aOR= 3.10 (95%CI=2.90–3.32)]. Conclusions: FIT-colonoscopy was associated with more than two-fold risk of significant bleeding, especially when polypectomy is performed.

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Demand for Colonoscopy in Colorectal Cancer Screening Using a Quantitative Fecal Immunochemical Test and Age/Sex-Specific Thresholds for Test Positivity

Abstract: Background: Despite age and sex differences in fecal hemoglobin (fHb) concentrations, most

Cited by 14 publications

References 19 publications

Effect of Sex, Age, and Positivity Threshold on Fecal Immunochemical Test Accuracy: A Systematic Review and Meta-analysis

Effect of Sex, Age, and Positivity Threshold on Fecal Immunochemical Test Accuracy: A Systematic Review and Meta-analysis

Overestimated Sensitivity of Fecal Immunochemical Tests in Screening Cohorts With Registry-Based Follow-up

Risk of colonoscopy-related complications in a fecal immunochemical test-based population colorectal cancer screening program

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