Prescription drugs associated with false-positive results when using faecal immunochemical tests for colorectal cancer screening

Ibáñez‐Sanz, Gemma; Garcia, Montse; Rodríguez-Moranta, Francisco; Binefa, Gemma; Gómez-Matas, Javier; Domènech, Xènia; Vidal, Carmen; Soriano, Antonio

doi:10.1016/j.dld.2016.06.011

Cited by 18 publications

(28 citation statements)

References 36 publications

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“…Only among women over 65 did PPVs exceed 40% at most hemoglobin cutoff values, supporting the importance of age and sex in optimizing screening strategies . Reported effects of age on false positivity have been inconsistent, and in this study, we saw no association.…”

Section: Discussionsupporting

confidence: 83%

“…Although each condition was uncommon in the study sample, the prevalence of any was 5% and doubled the odds of a FP FIT. These findings support previous associations with false positivity reported for the presence of hemorrhoids (ORs 1.1‐2.9), diverticula (OR = 1.9), and anal fissure (OR = 3.7) . Although these conditions can be discovered during colonoscopy, we relied on diagnosis codes at the time of FIT eligibility determination to ascertain them, and the symptoms and comorbidities that led to the diagnoses are unknown.…”

Section: Discussionsupporting

confidence: 83%

“…Use of NSAIDs was not significantly associated with false positivity, which may be due to a lower CRC risk among NSAID users . Previous studies have reported significant associations between use of antiplatelet medication (OR for false positivity ≈2.5) or proton‐pump inhibitors (OR = 1.8) . We found no association between anticoagulant use and false positivity.…”

Section: Discussionmentioning

confidence: 99%

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Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

et al. 2018

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Annual fecal immunochemical testing (FIT) is cost‐effective for colorectal cancer (CRC) screening. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false‐positive (FP) results adding to colonoscopy burden without improving cancer detection. Our objective was to describe FIT PPV and the factors associated with FP results among patients undergoing CRC screening. In an ongoing pragmatic clinical trial of mailed‐FIT outreach, clinics delivered one of three FIT brands (InSure, OC‐Micro, and Hemosure). Patients who had a positive FIT result and a follow‐up colonoscopy were included in this analysis (N = 1130). Patients’ demographic and medical histories were abstracted from electronic health records (EHR). Associations with a FP result (ie, a positive FIT result with no evidence of advanced neoplasia during follow‐up colonoscopy) were evaluated for FIT brand and patient factors using mixed‐effects multivariable logistic regression. The mean proportion of FIT‐positive results ranged from 8% in centers using the OC‐Micro test to 21% for Hemosure. PPVs for advanced neoplasia were 0.30 to 0.17, respectively (P for χ 2 = 0.08). In multivariable‐adjusted models, use of Hemosure was associated with greater odds of a FP result than OC‐Micro (OR = 2.00, 95% CI: 0.47‐8.56) or InSure (OR = 1.72, 95% CI: 0.44‐6.68). However, only female sex (OR = 1.58, 95% CI: 1.19‐2.10) and history of a colorectal condition (OR = 2.17, 95% CI: 1.13‐4.15) were significantly associated with FP. In conclusion, FIT positivity varied by brand, and FP results differed by patient factors available through the EHR. These results can be used to minimize the frequency of FP results, reducing patient distress and colonoscopy burden.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

et al. 2018

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“…A recently published study by Ibáñez-Sanz et al , identified female gender, successive screening, haemorrhoids or anal fissure, and PPI use to be risk factors for FP results in CRC screening programme [21]. Their results are consistent with those of our study.…”

Section: Discussionsupporting

confidence: 92%

“…Recently, a study performed by Ibañez et al . to evaluate the influence of prescription drugs on the accuracy of FIT in colorectal cancer screening found that the use of PPI was associated with false-positive results of FIT [21]. Nevertheless, this study did not include the result of the colonoscopy of patients with a negative FIT and in consequence, the influence of PPI on the sensitivity and specificity of the test could not be ascertained.…”

Section: Introductionmentioning

confidence: 99%

Proton pump inhibitors reduce the accuracy of faecal immunochemical test for detecting advanced colorectal neoplasia in symptomatic patients

et al. 2018

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BackgroundThe faecal immunochemical test (FIT) is used in colorectal cancer (CRC) screening and for the detection of advanced colorectal neoplasia (AN) in symptomatic patients, but its accuracy could be improved. Our objective was to assess the impact of proton pump inhibitors (PPI) on the accuracy of the FIT in the detection of AN, namely advanced colorectal adenoma and CRC.Methods and findingsWe performed a prospective study of 1002 individuals referred for a diagnostic colonoscopy at Bellvitge University Hospital from September 2011 through to October 2012. An exhaustive interview was performed by a gastroenterologist, prescription drug dispensing database was reviewed and the patient was given a FIT prior to colonoscopy. The positivity threshold of FIT used was ≥ 20 μg Hb/g feces and the main outcome was AN. AN was detected in 13.2% (133) of patients. The accuracy of FIT for detecting AN in the PPI users and non-PPI users were: sensitivity 43.0% vs 65.6%, P = 0.009; specificity 86.9% vs 92.3%, P = 0.010; and, predictive positive value 34.4% vs 55.5%, P = 0.007, respectively. In multivariate analysis, adjusting for potential confounders, PPIs were associated with false positives in AN detection by FIT (OR 1.63 CI 95% 1.02–2.59, P < 0.037). The ROC curve for the FIT in the detection of AN in the PPI users and non-PPI users was 0.68 (CI 95% 0.61–0.76) and 0.85 (CI 95% 0.79–0.90).ConclusionsPPI therapy reduces the accuracy of FIT for detecting AN in symptomatic patients.

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False-positive fecal immunochemical test results in colorectal cancer screening and gastrointestinal drug use

Arnal

Mateo

Hermoso-Durán

et al. 2021

Int J Colorectal Dis

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Prescription drugs associated with false-positive results when using faecal immunochemical tests for colorectal cancer screening

Cited by 18 publications

References 36 publications

Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

Proton pump inhibitors reduce the accuracy of faecal immunochemical test for detecting advanced colorectal neoplasia in symptomatic patients

False-positive fecal immunochemical test results in colorectal cancer screening and gastrointestinal drug use

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