Abstract
BackgroundFaecal immunochemical tests (FITs) have replaced guaiac-based faecal occult blood test (gFOBTs) in several colorectal cancer (CRC) screening programmes. We aimed to evaluate the benefits of this transition based on the Wallonia–Brussels-organised CRC screening programme.MethodsA total of 1,569,868 individuals aged 50–74 years, who were invited to screening during 2009–2017, were studied by linking their screening records with insurance, pathology and cancer data in the Belgian Cancer Registry. We compared neoplasm detection rates and positive predictive values (PPVs) of gFOBT and FIT at 15 µg haemoglobin per gram cut-off in screen-naive individuals. We furthermore examined the incidence rates of interval cancer in gFOBT- and FIT-based screening programme.ResultsAdvanced neoplasms were detected less frequently by gFOBT (0.8%) than by FIT (1.3%), with a difference of 0.5% (P < 0.01). PPVs were lower for gFOBT (15.1%) than for FIT (21.7%) for advanced neoplasms (difference 6.6%, P < 0.01). Compared to participants with negative gFOBT, those with negative FIT were 77% less likely to develop interval cancer (incidence rate ratio 0.23, 95% confidence interval 0.16–0.33).ConclusionOur study demonstrated that in an organised CRC screening programme, replacing gFOBT with FIT improved neoplasm detection rate and substantially reduced interval cancer incidence.
Highlights
Faecal immunochemical tests (FITs) have replaced guaiac-based faecal occult blood test in several colorectal cancer (CRC) screening programmes
Advanced neoplasms were found in 720 of the guaiac-based faecal occult blood test (gFOBTs) participants (0.8%) and in 373 of the FIT participants (1.3%), with a difference of 0.5%
positive predictive values (PPVs) were lower for gFOBT than for FIT: 6.5% vs. 6.9% for CRC, and 15.1% vs. 21.7% for any advanced neoplasm
Summary
Faecal immunochemical tests (FITs) have replaced guaiac-based faecal occult blood test (gFOBTs) in several colorectal cancer (CRC) screening programmes. CONCLUSION: Our study demonstrated that in an organised CRC screening programme, replacing gFOBT with FIT improved neoplasm detection rate and substantially reduced interval cancer incidence. Faecal immunochemical tests (FITs), which were shown to be more sensitive for colorectal adenomas and CRCs,[4,5,6,7,8,9] have replaced gFOBT or have been newly introduced in many CRC screening programmes.[8,10] according to a recent European Union-funded report on cancer screening programmes, in some countries, such as Croatia, Finland, Latvia and Sweden, gFOBTs were still offered as primary CRC screening tests.[11] Previous studies have demonstrated that replacing gFOBT by FIT in pilot screening programmes markedly increased the participation rate and yield of advanced neoplasia.[12,13,14] implementation of FIT-based screening has been widely recommended, empirical evidence on the impact of switching from gFOBT- to FIT-based screening on key outcome variables of screening on the population level is yet very limited
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