High sensitivity of five colorectal screening programmes with faecal immunochemical test in the Veneto Region, Italy

Zorzi, Manuel; Fedato, Chiara; Grazzini, Grazia; Stocco, Fiorella Carmen; Banovich, Flavio; Bortoli, Antonio; Cazzola, Luigi; Montaguti, A; Moretto, Tina; Zappa, Marco; Vettorazzi, M

doi:10.1136/gut.2010.223982

Cited by 62 publications

(57 citation statements)

References 30 publications

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“…While the fecal immunochemical test (FIT) is widely used in population-based screening for colorectal neoplasia and is effective in reducing colorectal cancer mortality through early detection, [1][2][3][4][5][6][7][8][9][10][11][12] it has been not yet known whether the detailed information on quantitative fecal hemoglobin concentration (FHbC) available with the FIT might also be of use for predicting the risk of colorectal neoplasia. Unfortunately, because clinical practice is to select subjects with FHbC greater than a set cut-off for further clinical investigation the precise value of FHbC, although measured and often reported, is largely neglected.…”

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confidence: 99%

A new insight into fecal hemoglobin concentration‐dependent predictor for colorectal neoplasia

Yen

Chen

Chiu

et al. 2014

Intl Journal of Cancer

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We sought to assess how much of the variation in incidence of colorectal neoplasia is explained by baseline fecal hemoglobin concentration (FHbC) and also to assess the additional predictive value of conventional risk factors. We enrolled subjects aged 40 years and over who attended screening for colorectal cancer with the fecal immunochemical test (FIT) in Keelung community-based integrated screening program. The accelerated failure time model was used to train the clinical weights of covariates in the prediction model. Datasets from two external communities were used for external validation. The area under curve (AUC) for the model containing only FHbC was 83.0% (95% CI: 81.5-84.4%), which was considerably greater than the one containing only conventional risk factors (65.8%, 95% CI: 64.2-67.4%). Adding conventional risk factors did not make significant additional contribution (p 5 0.62, AUC 5 83.5%, 95% CI: 82.1-84.9%) to the predictive model with FHbC only. Males showed a stronger linear dose-response relationship than females, yielding gender-specific FHbC predictive models. External validation confirms these results. The high predictive ability supported by a dose-dependent relationship between baseline FHbC and the risk of developing colorectal neoplasia suggests that FHbC may be useful for identifying cases requiring closer postdiagnosis clinical surveillance as well as being an early indicator of colorectal neoplasia risk in the general population. Our findings may also make contribution to the development of the FHbC-guided screening policy but its pros and cons in connection with cost and effectiveness of screening should be evaluated before it can be applied to population-based screening for colorectal cancer.While the fecal immunochemical test (FIT) is widely used in population-based screening for colorectal neoplasia and is effective in reducing colorectal cancer mortality through early detection, 1-12 it has been not yet known whether the detailed information on quantitative fecal hemoglobin concentration (FHbC) available with the FIT might also be of use for predicting the risk of colorectal neoplasia. Unfortunately, because clinical practice is to select subjects with FHbC greater than a set cut-off for further clinical investigation the precise value of FHbC, although measured and often reported, is largely neglected. The previous study reported that baseline FHbC can be predictive of incident colorectal neoplasia among screening participants who test negative at the first screen. 13 Nonetheless, it is not possible to fully investigate the relationship between risk of developing colorectal neoplasia and having a high FHbC because the natural history of the disease in those with FHbC levels above the cut off is interrupted owing to the administration of medical regime. To assess the predictive power of FHbC as a measure of risk of colorectal neoplasia one must develop a risk model based on FHbC (measured as a continuous variable at baseline in those testing both negative and positive according t...

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confidence: 99%

A new insight into fecal hemoglobin concentration‐dependent predictor for colorectal neoplasia

Yen

Chen

Chiu

et al. 2014

Intl Journal of Cancer

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“…We are soon going to publish the sensitivity estimates of five Italian iFOBT-based screening programmes according to the proportional method 3. Now, in order to evaluate the seasonal variability of sensitivity, we have collected information about the date of the last negative screening test before the diagnosis of IC and estimated the season-specific sensitivity.…”

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confidence: 99%

Limited effect of summer warming on the sensitivity of colorectal cancer screening: Table 1

Zorzi

Baracco

Fedato

2010

Gut

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In their recent paper, Grazzini and colleagues 1 reported a decrease in the positivity of the immunochemical faecal occult blood test (iFOBT) for colorectal cancer screening during the summer period. Their results predict a higher rate of false-negative iFOBT results during the hot season. This effect is likely to be higher for patients with minor neoplastic lesions, where the haemoglobin concentration in faeces is usually lower 2 than in patients with larger adenomas or invasive cancers.Evaluating the seasonal proportional incidence of interval cancers (ICs) and hence the sensitivity of iFOBT-based screening programmes may help to clarify this point.We are soon going to publish the sensitivity estimates of five Italian iFOBT-based screening programmes according to the proportional method. 3 Now, in order to evaluate the seasonal variability of sensitivity, we have collected information about the date of the last negative screening test before the diagnosis of IC and estimated the season-specific sensitivity. The ICs that were diagnosed after a positive iFOBT followed by a negative assessment or a refusal of colonoscopy were excluded. Table 1 shows the positivity rates, the proportional incidence and the sensitivity in the summer versus the other seasons of the year.We observed a significant reduction in the positivity rates in the summer compared with the other seasons (4.53% vs 4.97%, with p<0.0001) as well as a lower sensitivity (although not at a significant level). In particular, summer showed the highest proportional incidence during the first interval-year after the screening episode (18.6% vs 12.9% in the other seasons taken altogether).It is also remarkable that winter scored both the highest positivity and sensitivity.It should be recognised that the sensitivity observed in the summer is still very good, when compared, for instance, with the standard for the sensitivity of breast cancer screening (proportional incidence <30% in the first interval-year and <50% in the second). 4 In our experience, iFOBT is still a highly satisfactory test for the first level of colorectal cancer screening, notwithstanding the reduced performance in the summer.

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“…33,34 Prevalent undetected cancers were later stage than cancers considered not detectable, and both undetected and not detectable cancers were later stage than screening-detected cancers, consistent with other studies of interval cancer. 35 In conclusion, in the PLCO trial, prevalent lesions not detected by FSG screening were more often attributable to factors associated with patient compliance or limitations in sigmoidoscopy rather than an endoscopic failure of detection. By using colonoscopy rather than sigmoidoscopy as the initial screening modality, an additional 15.6% and up to 19% of cancers may have been screening detected.…”

Section: Discussionmentioning

confidence: 96%

Colorectal cancers not detected by screening flexible sigmoidoscopy in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Schoen

Pinsky

Weissfeld

et al. 2012

Gastrointestinal Endoscopy

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High sensitivity of five colorectal screening programmes with faecal immunochemical test in the Veneto Region, Italy

Cited by 62 publications

References 30 publications

A new insight into fecal hemoglobin concentration‐dependent predictor for colorectal neoplasia

A new insight into fecal hemoglobin concentration‐dependent predictor for colorectal neoplasia

Limited effect of summer warming on the sensitivity of colorectal cancer screening: Table 1

Colorectal cancers not detected by screening flexible sigmoidoscopy in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

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