Results of Compliant Participation in Five Rounds of Fecal Immunochemical Test Screening for Colorectal Cancer

Baldacchini, Flavia; Bucchi, Lauro; Giuliani, Orietta; Mancini, Silvia; Ravaioli, Alessandra; Vattiato, Rosa; Rossi, Paolo Giorgi; Campari, Cinzia; Canuti, Debora; Felice, Enza Di; Mezzetti, Francesca; Bianchi, Priscilla Sassoli de; Ferretti, Stefano; Falcini, Fabio; Ventura, Chiara; Colamartini, Americo; Signorelli, Dario; Aragona, Giovanni; Pennini, Francesca; Chiaranda, Giorgio; Seghini, Pietro; Fiora, Cristian Dalla; Fattibene, Claudio; Michiara, Maria; Orsi, Paolo; Mangone, Lucìa; Sassatelli, Romano; Carrozzi, Giuliano; Rossi, Federica; Esposito, Pasqualina; Trande, P.; Viani, Simona; Ricciardiello, Luigi; Cennamo, Vincenzo; Gualandi, G; Caprara, L; Lillo, Margherita De; Togni, Aldo De; Palmonari, Caterina; Pasquali, Daniela; Zoli, Giorgio; Re, Serena Dal; Petrini, C.A.A.; Serafini, Monica; Triossi, O.; Vitali, B; Gallinucci, Mara; Imolesi, Claudia; Palazzi, Mauro; Fabbri, Carlo; Casale, C.; Giovanardi, M.; Trombetti, Daniele

doi:10.1016/j.cgh.2020.08.038

Cited by 19 publications

(14 citation statements)

References 23 publications

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“…Ours was a population-based study using cancer registry data for an entire region in Italy rather than from a single centre. We were also able to adjust for screening status in a region where a CRC screening programme has been active since 2005, with a 50% participation rate [ 31 ]. Screening has changed the epidemiological profile of colorectal cancer in Italy and has also had an impact on survival [ 2 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Colon cancer survival differs from right side to left side and lymph node harvest number matter

et al. 2021

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Background Right-sided colorectal cancer (CRC) has worse survival than does left-sided CRC. The objective of this study was to further assess the impact of right-side location on survival and the role of the extent of lymphadenectomy. Methods All CRCs diagnosed between 2000 and 2012 in Emilia-Romagna Region, Italy, were included. Data for stage, grade, histology, screening history, and number of removed lymph nodes (LN) were collected. Multivariable Cox regression models were used to estimate hazard ratios (HR), with relative 95% confidence intervals (95%CI), of right vs. left colon and of removing < 12, 12–21 or > 21 lymph nodes by cancer site. Results During the study period, 29,358 patients were registered (8828 right colon, 18,852 left colon, 1678 transverse). Patients with right cancer were more often older, females, with advanced stage and high grade, and higher number of removed LNs. Five-year survival was lower in the right than in the left colon (55.2% vs 59.7%). In multivariable analysis, right colon showed a lower survival when adjusting for age, sex, and screening status (HR 1.12, 95%CI 1.04–1.21). Stratification by number of lymph nodes removed (12–21 or > 21) was associated with better survival in right colon (HR 0.54, 95%CI 0.40–0.72 and HR 0.40, 95%CI 0.30–0.55, respectively) compared to left colon (HR 0.89, 95%CI 0.76–1.06 and HR 0.83, 95%CI 0.69–1.01, respectively). Conclusions This study confirms that right CRC has worse survival; the association is not due to screening status. An adequate removal of lymph nodes is associated with better survival, although the direction of the association in terms of causal links is not clear.

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Section: Discussionmentioning

confidence: 99%

Colon cancer survival differs from right side to left side and lymph node harvest number matter

et al. 2021

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“…One limitation of the study is that it was not possible to analyze the sensitivity and specificity for both CRC detection and adenomas, as we cannot count the number of adenomas not detected by the FIT. Another limitation is that other variables that have been shown to be related to FIT performance, such as tobacco use or personal history of FIT screening tests in previous participations [19,28] are not included in the study.…”

Section: Plos Onementioning

confidence: 99%

Optimal cut-off value for detecting colorectal cancer with fecal immunochemical tests according to age and sex

et al. 2021

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In the fecal immunological test, a suitable cut-off value may be selected to classify results as either positive or negative. Our aim is to estimate the optimal cut-off value for detecting colorectal cancer in different age and sex groups. This is a multicentric retrospective cohort study of participants in CRC screening programs with FIT between 2006 and 2012. A total of 545,505 participations were analyzed. Cancers diagnosed outside of the program were identified after a negative test result (IC_test) up until 2014. The Wilcoxon test was used to compare fecal hemoglobin levels. ROC curves were used to identify the optimal cut-off value for each age and sex group. Screening program results were estimated for different cut-off values. The results show that the Hb concentration was higher in colorectal cancer (average = 179.6μg/g) vs. false positives (average = 55.2μg/g), in IC_test (average = 3.1μg/g) vs. true negatives (average = 0μg/g), and in men (average = 166.2μg/g) vs. women (average = 140.2μg/g) with colorectal cancer. The optimal cut-off values for women were 18.3μg/g (50-59y) and 14.6μg/g (60-69y), and 16.8μg/g (50-59y) and 19.9μg/g (60-69y) for men. Using different cut-off values for each age and sex group lead to a decrease in the IC_test rate compared to the 20μg/g cut-off value (from 0.40‰ to 0.37‰) and an increase in the false positive rate (from 6.45% to 6.99%). Moreover, test sensitivity improved (90.7%), especially in men and women aged 50-59y (89.4%; 90%) and women aged 60-69y (90.2%). In conclusion, the optimal cut-off value varies for different sex and age groups and the use of an optimal cut-off value for each group improves sensitivity and leads to a small decrease in IC_tests, but also to a larger increase in false positives.

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“…In order to define which groups could be excluded from screening, we compared the cumulative CRC incidence and mortality observed for each study subgroup (according to sex and number of negative FITs, for example, “women with three negative FITs”) with different reference thresholds: The cumulative CRC risk recommended as the appropriate threshold (3% over 15 years) for offering screening in a recent guideline, based on modeling of the expected benefit‐to‐harm ratio 14 The 5‐year and 10‐year cumulative CRC incidence and mortality of a cohort of subjects aged 50 years (ie, the cohort with the lowest CRC incidence that is included in the screening program) and of a cohort of subjects aged 45 years (whose risk is deemed to be low enough to justify its exclusion from screening in Italy).…”

Section: Methodsmentioning

confidence: 99%

“…The cumulative CRC risk recommended as the appropriate threshold (3% over 15 years) for offering screening in a recent guideline, based on modeling of the expected benefit-to-harm ratio. 14 2. The 5-year and 10-year cumulative CRC incidence and mortality of a cohort of subjects aged 50 years (ie, the cohort with the lowest CRC incidence that is included in the screening program) and of a cohort of subjects aged 45 years (whose risk is deemed to be low enough to justify its exclusion from screening in Italy).…”

Section: What's New?mentioning

confidence: 99%

“…Several studies reported a lower detection rate of CRC and, to a lesser extent, of advanced adenoma among subjects who had repeated negative FIT exams tests, which would suggest that CRC risk might tend to decrease in this subgroup. 8,[12][13][14] Stratifying 70-year-old subjects according to their risk of CRC, could allow dismissing from screening those at low risk of disease, although evidence to support the adoption of specific incidence and/or mortality thresholds for stopping screening is limited and controversial.…”

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Colorectal cancer incidence and mortality after negative fecal immunochemical tests by age 70: A prospective observational study

Zorzi

Battagello

Fiore

et al. 2021

Intl Journal of Cancer

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Limited endoscopy capacity usually represents the main barrier to the extension of screening to subjects older than 70, given the high positivity rate in this age group. We assessed CRC incidence and mortality by number of previous negative fecal immunochemical tests (FIT) among subjects turning 70. We selected persons aged 70 years who had received their last screening invitation when they were 68 or 69 years old within the populationbased screening program in the Veneto region of Italy. Subjects with a positive FIT were excluded. We calculated 10-year cumulative CRC incidence and mortality in cohorts of subjects having performed zero, one, two or three negative FITs over the last three screening rounds before turning 70. Out of 117 858 subjects included in the study (46.4% men), 33.7% had never participated in screening (zero negative FITs), 23.3% had had onenegative FIT, 20.1% two-negative FITs and 22.9% three negative FITs. The 10-year cumulative CRC incidence was 29.7 per 1000 subjects with zero FITs, and respectively, 14.5, 11.7 and 9.6 per 1000 subjects with one, two and three negative FITs. The corresponding figures for 10-year cumulative mortality were 9.3, 3.5, 2.2 and 2.1 per 1000 in the four study cohorts. Figures were roughly double for men than for women for all the study cohorts. In order to use more efficiently limited endoscopy resources, and to minimize the potential harms related to false positive results in the elderly, screening among people aged 70 to 74 might be restricted to those with zero previous negative FITs.

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Results of Compliant Participation in Five Rounds of Fecal Immunochemical Test Screening for Colorectal Cancer

Cited by 19 publications

References 23 publications

Colon cancer survival differs from right side to left side and lymph node harvest number matter

Colon cancer survival differs from right side to left side and lymph node harvest number matter

Optimal cut-off value for detecting colorectal cancer with fecal immunochemical tests according to age and sex

Colorectal cancer incidence and mortality after negative fecal immunochemical tests by age 70: A prospective observational study

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