Abstract
ObjectivesThe National Health Service Bowel Cancer Screening Programme (NHS BCSP) in England has replaced guaiac faecal occult blood testing by faecal immunochemical testing (FIT). There is interest in fully exploiting FIT measures to improve bowel cancer (CRC) screening strategies. In this paper, we estimate the relationship of the quantitative haemoglobin concentration provided by FIT in faecal samples with underlying pathology. From this we estimate thresholds required for given levels of sensitivity to CRC and high-risk adenomas (HRA).MethodsData were collected from a pilot study of FIT in England in 2014, in which 27,238 participants completed a FIT. Those with a faecal haemoglobin concentration (f-Hb) of at least 20 µg/g were referred for further investigation, usually colonoscopy. Truncated regression models were used to explore the relationship between bowel pathology and FIT results. Regression results were applied to estimate sensitivity to different abnormalities for a number of thresholds.ResultsParticipants with CRC and HRA had significantly higher f-Hb, and this remained unchanged after adjusting for age and sex. While a threshold of 20 μg/g was estimated to capture 82.2% of CRC and 64.0% of HRA, this would refer 7.8% of participants for colonoscopy. The current programme threshold used in England of 120 μg/g was estimated to identify 47.8% of CRC and 25.0% of HRA.ConclusionsUnder the current diagnostic policy of dichotomising FIT results, a very low threshold would be required to achieve high sensitivity to CRC and HRA, which would place further strain on colonoscopy resources. The NHS BCSP in England might benefit from a diagnostic policy that makes greater use of the quantitative nature of FIT.
Highlights
IntroductionBowel cancer (colorectal cancer, cm in diameter; 4. Cancer (CRC)) is the second most common cause of cancer death in the UK, accounting for 10% of all cancer deaths in 2017.1 Between 2015 and 2017, there were around 16,300 CRC deaths in the UK every year, equivalent to 45 deaths every day.[1] In order to reduce mortality and incidence of CRC, the National Health Service Bowel Cancer Screening Programme (NHS BCSP) in England offers tests for the presence of occult blood in faeces free of charge every two years for men and women aged 60–74 years (inclusive)
Bowel cancer is the second most common cause of cancer death in the UK, accounting for 10% of all cancer deaths in 2017.1 Between 2015 and 2017, there were around 16,300 cm in diameter; 4. Cancer (CRC) deaths in the UK every year, equivalent to 45 deaths every day.[1]
This paper aims to complement the previous results by: 1. Exploring the relationship between faecal immunochemical test (FIT) results and bowel pathology using truncated regression, in both a univariate and multiple regression model, with demographic factors including age, sex and area-based socioeconomic status; and
Summary
Bowel cancer (colorectal cancer, CRC) is the second most common cause of cancer death in the UK, accounting for 10% of all cancer deaths in 2017.1 Between 2015 and 2017, there were around 16,300 CRC deaths in the UK every year, equivalent to 45 deaths every day.[1] In order to reduce mortality and incidence of CRC, the National Health Service Bowel Cancer Screening Programme (NHS BCSP) in England offers tests for the presence of occult blood in faeces free of charge every two years for men and women aged 60–74 years (inclusive). Faecal immunochemical test (FIT) gives a quantitative result in the form of micrograms of haemoglobin per gram of faeces (lg/g), and requires only a single sample.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
