Estimation of screening test (Hemoccult®) sensitivity in colorectal cancer mass screening

Abstract

Summary 3 controlled cohorts of mass-screening for colorectal cancer using a biennial faecal occult blood (HemoccultII ® ) test on well-defined European populations have demonstrated a 14% to 18% reduction in specific mortality. We aimed to estimate the sensitivity (S) of this HemoccultII ® test and and also mean sojourn time (MST) from French colorectal mass-screening programme data. 6 biennial screening rounds were performed from 1988 to 1998 in 45 603 individuals aged 45-74 years in Saône-et-Loire (Burgundy, France). The prevalent/incidence ratio was calculated in order to obtain a direct estimate of the product S.MST. The analysis of the proportional incidence and its modelling was used to derive an indirect estimate of S and MST. The product S.MST was higher for males than females and higher for left colon than either the right colon or rectum. The analysis of the proportional incidence confirmed the result for subsites but no other significant differences were found. The sensitivity was estimated at 0.57 and the MST at 2.56 years. This study confirms that the sensitivity of the Hemoccult test is relatively low and that the relatively short sojourn time is in favour of annual screening.

Modeling recurrence in colorectal cancer

“…For example, in 1979 Jamieson [19] reported this bias in the analysis of the Stanford Heart Transplant data. This phenomenon has been frequently observed in the framework of cancer screening [18,20,21].…”

Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths

“…14,15 On the basis of the available literature, we estimated an average sojourn time for colorectal cancer of 3 years (range, 2 to 5). 13,16-18 …”

Sensitivity of latex agglutination faecal occult blood test in the Florence District population-based colorectal cancer screening programme

“…Randomised trials demonstrating FOBT screening effectiveness used a 3-day guaiac-based test (G-FOBT), a chemical test based on haemoglobin peroxidase-like activity whose accuracy is affected by dietary factors such as the presence of nonhuman haemoglobin and peroxidases in vegetables, or by certain drugs, particularly NSAIDs. Sensitivity of G-FOBT for CRC has been reported to be as low as 43-66%, based on a 2-year screening interval (Jensen et al, 1992;Launoy et al, 1997;Moss et al, 1999;Jouve et al, 2001); attempts to increase sensitivity either by rehydration (Church et al, 1997) or by increased reagent concentration (Petrelli et al, 1994;Allison et al, 1996) were associated with unacceptable loss in specificity. Several studies have suggested that immunochemical FOBT (I-FOBT) is more sensitive and specific than G-FOBT Saito et al, 2000;Zappa et al, 2001; Levi et al, 2006;Guittet et al, 2007), requiring no dietary restrictions, and might substantially improve screening cost effectiveness Saito et al, 2000).…”