Stage distribution of screen-detected colorectal cancers in the Netherlands

Toes‐Zoutendijk, Esther; Kooyker, Arthur I.; Elferink, M.A.G.; Spaander, Manon C.W.; Dekker, Evelien; Koning, Harry J. de; Lemmens, V.; Leerdam, Monique E. van; Lansdorp–Vogelaar, Iris

doi:10.1136/gutjnl-2017-315111

Cited by 47 publications

(53 citation statements)

References 9 publications

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“…In contrast, location of the interval CRC is substantially different from that of CRCs detected after symptoms, with many more rightsided interval CRCs, suggesting a lower FIT sensitivity for right-sided CRCs. 22 The major strength of this study is the opportunity of comparing 2 FIT cutoffs, applied in the same population within an organized CRC screening program. We obtained valuable information on the impact of using a higher cutoff.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Interval Colorectal Cancer After Negative Results From First-Round Fecal Immunochemical Screening Tests, by Cutoff Value and Participant Sex and Age

Toes‐Zoutendijk

Kooyker

Dekker

et al. 2020

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS: We evaluated the incidence of interval cancers between the first and second rounds of colorectal cancer (CRC) screening with the FOB-Gold fecal immunochemical test (FIT), and the effects of different cutoff values and patient sex and age. METHODS: We collected data from participants in a population-based CRC screening program in the Netherlands who had a negative result from a first-round of FIT screening. We calculated the cumulative incidence of interval cancer after a negative result from a FIT and the sensitivity of the FIT for detection of CRC at a low (15 mg Hb/g feces) and high (47 mg Hb/g feces) cutoff value. RESULTS: Among the 485,112 participants with a negative result from a FIT, 544 interval cancers were detected; 126 were in the 111,800 participants with negative results from a FIT with the low cutoff value and 418 were in the 373,312 FIT participants with negative results from a FIT with the high cutoff value. The mean age of participants tested with the low cutoff value was 72.0 years and the mean age of participants tested the high cutoff value was 66.7 years. The age-adjusted 2-year cumulative incidence of interval cancer after a negative result from a FIT were 9.5 per 10,000 persons at the low cutoff value vs 13.8 per 10,000 persons at the high cutoff value (P < .005). The age-adjusted sensitivity of the FIT for CRC were 90.5% for the low cutoff value vs 82.9% for the high cutoff (P < .0001). The FIT identified men with CRC with 87.4% sensitivity and women with CRC with 82.6% sensitivity (P < .001). CONCLUSIONS: In an analysis of data from a FIT population-based screening program in the Netherlands, we found that incidence of interval CRC after a negative result from a FIT to be low. Although the sensitivity of detection of CRC decreased with a higher FIT cutoff value, it remained above 80%.

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Section: Discussionmentioning

confidence: 99%

Incidence of Interval Colorectal Cancer After Negative Results From First-Round Fecal Immunochemical Screening Tests, by Cutoff Value and Participant Sex and Age

Toes‐Zoutendijk

Kooyker

Dekker

et al. 2020

Clinical Gastroenterology and Hepatology

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“…In 2015, 48% of detected CRCs in the Dutch screening program were stage I CRCs, in line with other Western countries. [1][2][3] T1 colorectal cancer (T1CRC) without metastasis is the earliest form of stage I CRC and is defined as tumor growing through the muscularis mucosae into the submucosa without invading the muscularis propria. 4 Lymph node metastasis (LNM) risk of T1CRC is 8% to 14%.…”

Section: Discussionmentioning

confidence: 99%

Pedunculated Morphology of T1 Colorectal Tumors Associates With Reduced Risk of Adverse Outcome

Kessels

Backes

Elias

et al. 2019

Clinical Gastroenterology and Hepatology

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“…It is generally agreed that screening will eventually result in earlier stage at diagnosis and that this is associated with a better prognosis. [10][11][12][13] However, the impact of fecal occult blood tests screening on a surgical CRC audit is less clear with several potential influences. First, earlier cancer stage will enable more nonsurgical treatment using endoscopic removal (with or without laparoscopic assistance), and these patients are not included in the DCRA.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes of Screen-Detected vs Non–Screen-Detected Colorectal Cancer in the Netherlands

et al. 2018

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The nationwide fecal immunochemical test-based screening program has influenced surgical care for patients with colorectal cancer (CRC) in the Netherlands, although these implications have not been studied in much detail so far. OBJECTIVE To compare surgical outcomes of patients diagnosed as having CRC through the fecal immunochemical test-based screening program (screen detected) and patients with non-screen-detected CRC. DESIGN, SETTING, AND PARTICIPANTS This was a population-based comparative cohort study using the Dutch ColoRectal Audit and analyzed all Dutch hospitals performing CRC resections. Patients who underwent elective resection for CRC between January 2011 to December 2016 were included. INTERVENTIONS Colorectal cancer surgery. MAIN OUTCOMES AND MEASURES Postoperative nonsurgical complications, postoperative surgical complications, postoperative 30-day or in-hospital mortality, and complicated course (postoperative complication resulting in a hospital stay >14 days and/or a reintervention and/or mortality). A risk-stratified comparison was made for different postoperative outcomes based on screening status (screen detected vs not screen detected), cancer stage (I-IV), and for cancer stage I to III also on age (aged Յ70 years and >70 years) and American Society of Anesthesiologists score (I-II and III-IV). To determine any residual case-mix-corrected differences in outcomes between patients with screen-detected and non-screen-detected cancer, univariable and multivariable logistic regression analyses were performed. RESULTS In total, 36 242 patients with colon cancer and 17 416 patients with rectal cancer were included for analysis. Compared with patients with non-screen-detected CRC, screen-detected patients were younger (mean [SD] age, 68 [5] vs 70 [11] years), more often men (3777 [60%] vs 13 506 [57%]), and had lower American Society of Anesthesiologists score (American Society of Anesthesiologists score III+: 838 [13%] vs 5529 [23%]). Patients with stage I to III colon cancer who were screen detected had a significantly lower mortality and complicated course rate compared with non-screen-detected patients. For patients with rectal cancer, only a significant difference was found in mortality rate in patients with a cancer stage IV disease, which was higher in the screen-detected group. Compared with non-screen-detected colon cancer, an independent association was found for screen-detected colon cancer on nonsurgical complications (adjusted odds ratio, 0.81; 95% CI, 0.73-0.91), surgical complications (adjusted odds ratio, 0.80; 95% CI, 0.72-0.89), and complicated course (adjusted odds ratio, 0.80; 95% CI, 0.71-0.90). Screen-detected rectal cancer had significantly higher odds on mortality. CONCLUSIONS AND RELEVANCE Postoperative outcomes were significantly better for patients with colon cancer referred through the fecal immunochemical test-based screening program compared with non-screen-detected patients. These differences were not found in patients with rectal cancer. The outcomes of patients wit...

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Stage distribution of screen-detected colorectal cancers in the Netherlands

Cited by 47 publications

References 9 publications

Incidence of Interval Colorectal Cancer After Negative Results From First-Round Fecal Immunochemical Screening Tests, by Cutoff Value and Participant Sex and Age

Incidence of Interval Colorectal Cancer After Negative Results From First-Round Fecal Immunochemical Screening Tests, by Cutoff Value and Participant Sex and Age

Pedunculated Morphology of T1 Colorectal Tumors Associates With Reduced Risk of Adverse Outcome

Postoperative Outcomes of Screen-Detected vs Non–Screen-Detected Colorectal Cancer in the Netherlands

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