Abstract
BackgroundFaecal immunochemical tests (FITs) are commonly used in colorectal cancer (CRC) screening. Diagnostic accuracy of FIT differs between males and females. This so far unexplained difference could result in a dissimilarity in screening outcome between both sexes. The aim of this study is to compare sensitivity and specificity of a FIT between males and females, and study potential explanatory variables.MethodsIn this cross-sectional study, data were prospectively collected. 3,022 subjects performed a FIT prior to complete colonoscopy. Sensitivity, specificity, and ROC curves were compared for both sexes. Potential explanatory variables of the relation between sensitivity and sex were explored.ResultsAt all cut-off values, FIT sensitivity for CRC was higher (range 13-23%) and specificity was lower (range 2-4%) in males compared to females. At 75 ng/ml, sensitivity for CRC was 93% in males compared to 71% in females (p = 0.03), and specificity was 90% in males compared to 93% in females (p = <0.05). For advanced adenomas, males had a slightly higher sensitivity and lower specificity (not significant). At 75 ng/ml, sensitivity for advanced adenomas was 33% in males compared to 29% in females (p = 0.46), and specificity was 93% in males compared to 95% in females (p = 0.22). ROC curves were similar for both sexes, and equal combinations of sensitivity and specificity could be achieved by adjusting the cut-off values. For CRC, the difference in sensitivity could not be explained by age or location of the tumour.ConclusionsFIT has a higher sensitivity and a lower specificity for CRC in males than in females. Equal test characteristics can be achieved by allowing separate cut-off values for both sexes. Location and age do not explain the observed differences in sensitivity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-014-0217-7) contains supplementary material, which is available to authorized users.
Highlights
Faecal immunochemical tests (FITs) are commonly used in colorectal cancer (CRC) screening
It was found that FITs have a higher sensitivity and lower specificity for advanced colorectal neoplasia in males compared to females [3]
The aim of the present study is to investigate whether the sensitivity and specificity of a frequently used FIT for the detection of CRC and advanced adenomas differs between males and females, and whether this difference can be explained by age, location, number and/or size of neoplastic lesions
Summary
Faecal immunochemical tests (FITs) are commonly used in colorectal cancer (CRC) screening. Diagnostic accuracy of FIT differs between males and females. It was found that FITs have a higher sensitivity and lower specificity for advanced colorectal neoplasia in males compared to females [3]. Diagnostic accuracy of a screening test is just one of several factors determining the efficiency of a screening programme, a difference in FIT characteristics between males and females could implicate disparities in the expected benefit from CRC screening. Such a difference may require tailored screening. For example, a dissimilarity in advanced neoplasia distribution or a difference in the age of onset of CRC, remains to be resolved
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