Faecal immunochemical tests (FIT) versus colonoscopy for surveillance after screening and polypectomy: a diagnostic accuracy and cost-effectiveness study

Abstract

ObjectiveThe English Bowel Cancer Screening Programme (BCSP) recommends 3 yearly colonoscopy surveillance for patients at intermediate risk of colorectal cancer (CRC) postpolypectomy (those with three to four small adenomas or one ≥10 mm). We investigated whether faecal immunochemical tests (FITs) could reduce surveillance burden on patients and endoscopy services.DesignIntermediate-risk patients (60–72 years) recommended 3 yearly surveillance were recruited within the BCSP (January 2012–December 2013). FITs were offered at 1, 2 and 3 years postpolypectomy. Invitees consenting and returning a year 1 FIT were included. Participants testing positive (haemoglobin ≥40 µg/g) at years one or two were offered colonoscopy early; all others were offered colonoscopy at 3 years. Diagnostic accuracy for CRC and advanced adenomas (AAs) was estimated considering multiple tests and thresholds. We calculated incremental costs per additional AA and CRC detected by colonoscopy versus FIT surveillance.Results74% (5938/8009) of invitees were included in our study having participated at year 1. Of these, 97% returned FITs at years 2 and 3. Three-year cumulative positivity was 13% at the 40 µg/g haemoglobin threshold and 29% at 10 µg/g. 29 participants were diagnosed with CRC and 446 with AAs. Three-year programme sensitivities for CRC and AAs were, respectively, 59% and 33% at 40 µg/g, and 72% and 57% at 10 µg/g. Incremental costs per additional AA and CRC detected by colonoscopy versus FIT (40 µg/g) surveillance were £7354 and £180 778, respectively.ConclusionsReplacing 3 yearly colonoscopy surveillance in intermediate-risk patients with annual FIT could reduce colonoscopies by 71%, significantly cut costs but could miss 30%–40% of CRCs and 40%–70% of AAs.Trial registration numberISRCTN18040196; Results.

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

“…Several studies report on the long-term performance of FIT-based population screening programmes for CRC, but evidence for surveillance after polypectomy is lacking in these studies. One study reports on participants recruited between January 2012 and December 2013 via the English BCSP 92. Men and women aged 60–72 years, deemed at intermediate-risk following adenoma removal after a positive guaiac faecal occult blood test, were offered quantitative FIT at 1, 2 and 3 years post-polypectomy.…”

Identification of an Immune-Related Nine-lncRNA Signature Predictive of Overall Survival in Colon Cancer

“…A study found that the incidence and mortality of colon cancer have gradually increased in recent years (Bray et al, 2018). The current diagnostic strategies for colon cancer mainly include biopsy, laboratory examination, and colonoscopy (Cross et al, 2019;Kawamura et al, 2019). Therefore, establishing a reliable risk assessment model is urgently needed to assess the survival prognosis of patients with colon cancer and optimize clinical treatment decisions.…”

Reducing the number of surveillance colonoscopies with faecal immunochemical tests

“…We read with interest the article by Cross et al ,1 which examined the use of FIT in intermediate risk patients undergoing 3 yearly surveillance colonoscopies. The investigators assessed the diagnostic accuracy of this approach, together with the number of advanced adenomas and colorectal cancers missed, and the potential cost savings.…”