Fecal Immunochemical Test Test Research Articles

A randomized controlled trial of a multicomponent, targeted, low-literacy educational intervention compared with a nontargeted intervention to boost colorectal cancer screening with fecal immunochemical testing in community clinics.

The objective of the current study was to improve colorectal cancer (CRC) screening uptake with the fecal immunochemical test (FIT). The current study investigated the differential impact of a multicomponent, targeted, low-literacy educational intervention compared with a standard, nontargeted educational intervention. Patients aged 50 to 75 years who were of average CRC risk and not up-to-date with CRC screening were recruited from either a federally qualified health center or a primary care community health clinic. Patients were randomized to the intervention condition (targeted photonovella booklet/DVD plus FIT kit) or comparison condition (standard Centers for Disease Control and Prevention brochure plus FIT kit). The main outcome was screening with FIT within 180 days of delivery of the intervention. Of the 416 participants, 54% were female; the participants were racially and ethnically diverse (66% white, 10% Hispanic, and 28% African American), predominantly of low income, and insured (the majority had county health insurance). Overall, the FIT completion rate was 81%, with 78.1% of participants in the intervention versus 83.5% of those in the comparison condition completing FIT (P = .17). In multivariate analysis, having health insurance was found to be the primary factor predicting a lack of FIT screening (adjusted odds ratio, 2.10; 95% confidence interval, 1.04-4.26 [P = .04]). The multicomponent, targeted, low-literacy materials were not found to be significantly different or more effective in increasing FIT uptake compared with the nontargeted materials. Provision of a FIT test plus education may provide a key impetus to improve the completion of CRC screening. The type of educational material (targeted vs nontargeted) may matter less. The findings of the current study provide a unique opportunity for clinics to adopt FIT and to choose the type of patient education materials based on clinic, provider, and patient preferences. Cancer 2017;123:1390-1400. © 2016 American Cancer Society.

Poor Adherence Rates to Successive Fecal Immunochemical Testing for Colorectal Cancer Screening in an Underserved Population

Introduction: Current United States guidelines include fecal immunochemical testing (FIT) as an effective colorectal cancer screening modality when completed on a yearly basis. While FIT testing offers a lower cost option for screening, which is appealing to large safety-net health care systems such as ours, it is unclear what the adherence rate is to a yearly exam in an underserved population. This study aims to look at the adherence rate to successive FIT testing for screening in a largely underserved population served by a large safety-net health care system in Colorado. Methods: In our retrospective cohortstudy, patients were considered if they were 50 to 75 years of age and completed a FIT ordered by their primary care provider for screening purposes between April 1, 2012 and March 31, 2013. They were excluded if they had a prior colonoscopy for any reason. We evaluated whether patients with a negative FIT obtained a repeat test within the next 18 months, giving the patients an additional 6 months beyond the recommended yearly interval to account for variance in follow-up. We also took into account whether they may have undergone colonoscopy instead. Results: We included 4,827 patients in our initial cohort. 2,013 (42%) were male and 2,814 (58%) were female, with a mean age of 59 for both groups, and the majority self-identifying as Hispanic. Most (88%) were covered by public insurance or care programs. 481 (10%) of the initial FIT tests were reported as positive and 4,346 (90%) as negative. In the first follow-up period (April 1, 2013 to Sept 30, 2014), only 1,414 (30%) of the patients with an initially negative FIT repeated the test. 77 (5%) had a positive result and 1337 (95%) had a negative result. A small percentage (8%) underwent a colonoscopy for either diagnostic or screening purposes during that same period. Conclusion: We found that the adherence rate to yearly FIT for colorectal cancer screening purposes after one follow-up period in a large safety-net hospital serving a predominantly underserved population was low at 30%. This compares poorly to adherence rates within private health systems that reach 75-85%. This suggests that FIT, which is largely believed to be better tolerated and to yield higher adherence as a screening modality when compared to colonoscopy, may not be resulting in adequate colorectal cancer screening in certain populations. Additional research is underway looking at longer-term compliance to FIT.

Impact of Demographics and Socio-economic Status on Patientʼs Compliance to Perform Fecal Immunochemical Test (FIT): Experience from Urban-Minority Population

Introduction: Colorectal cancer (CRC) represents the 3rd most common cause of cancer-associated deaths in the United States. Widespread screening practices adhering to the guidelines established by the American College of Gastroenterology have substantially diminished the prevalence of CRC as well as its morbidity and mortality. Fecal Immunochemical Test (FIT) is one of the newer non-invasive stool based tests used to screen for CRC. FIT is more sensitive and specific than guaiac fecal occult blood test (FOBT) for CRC and advanced neoplasia. Routine recommendation is to repeat FIT annually for CRC screening. Our study is designed to see the difference in patient's compliance rates for initial and subsequent FIT testing based on their demographics and socioeconomic status in our urban-minority population in Brooklyn, New York. Methods: This is a retrospective observational study including all patients who qualified for CRC screening (as defined by ICD 10 codes Z12.11 and Z12.12) at NYU Lutheran Family Health Center Clinic from January2013-December 2015. Patients with the incomplete data were excluded. Statistical analysis used R Statistics v3.3 to establish FIT compliance rates and also performed bivariate comparisons of patient characteristics such as age, gender, ethnicity, and insurance status. Results: Out of 1574 charts reviewed 867 had a FIT ordered (Table 1). Initial and second FIT compliance was 80.2% and 66.2% respectively. Multiple orders of initial FIT tests prior to compliance were seen in 30.9%. 42.3% completed the FIT the same day as ordered, with 57.7% displaying a time-gap between ordering and completion of median 14 days with an interquartile range of 43 days. Age is the only significant predictor of FIT-related outcomes in our study; for each additional year of age, there were 8.5% less odds of having a second FIT ordered (OR 0.915, CI 0.874-0.955, P-value 0.0001).Table 1: Population Demographics of 867 patients with FIT OrderedConclusion: Our limited study demonstrates substandard compliance rates (1st FIT 80.2%, 2nd 66.2%) with almost a third of patients requiring multiple FIT orders to achieve compliance. These outcomes illustrate the FIT compliance issue in our urban-minority study population and we suspect that this is also true for the general population at large. Efforts are needed to increase the awareness for FIT administration in order to preserve health care resources and heighten adherence with CRC screening guidelines. However, further multicenter trials are needed to further validate our findings.

Improving Colorectal Cancer Screening and Surveillance Compliance with a Multidisciplinary Approach in the Outpatient Setting

Introduction: Colorectal cancer (CRC) is a common and preventable malignancy. Studies have shown that removal of premalignant adenomas can prevent cancer and cancer-related deaths. Screening tools have improved the incidence and mortality rates of CRC, along with shifting from late to early stage disease. Therefore, it is important to encourage preventative CRC screening (CRCS) and surveillance by primary care physicians. In this internal medicine outpatient office, compliance rate for CRCS and surveillance was below average at 53% in June 2015. The aim for this project was to develop and implement a tool to improve CRCS and surveillance compliance by 5% within a 12-month time frame among this practice's patients. Methods: We identified barriers to compliance which included lack of health literacy among this patient population, inability to do proper CRCS counseling in a 20-min office visit, and lack of knowledge about fecal immunochemical tests (FIT) as options among medical assistants (MA). We formed a multidisciplinary team of case manager, residents, faculty, and MAs to develop a Plan-Do-Study-Act (PDSA) for performance improvement. We used a quality assessment metrics program called Dashboard to assess compliance. Any patient who was non-compliant in both first and subsequent CRCS were identified. Interventions included educating the MAs on how to use FIT so they are motivated and empowered to provide this to patients, increasing educational information for patients about colonoscopy procedures and offering the option of FIT tests to non-compliant patients, and creating a preventative care form for each visit in order to alert physicians if patients are not up to date on preventative screening. The team met every month to evaluate ongoing progress. Compliance was measured monthly through Dashboard. Results: Since the implementation of the PDSA, compliance for CRCS in the internal medicine outpatient office has continued to improve 1-2% every month. In a 7-month period the compliance rate rose 12% from 53% to 65%. The result of the PDSA accomplished and then surpassed our initial clear aim. Conclusion: The team is continuing to meet on monthly bases to evaluate and modify our metrics to further improve our compliance rate. The implementation of the PDSA with the resulting rapid improvement demonstrates how a multidisciplinary approach for preventative care can improve patients' compliance for CRCS. We hope that this plan can be extrapolated to other gaps in preventative healthcare.Figure 1

Fecal Immunochemical Testing (FIT) for Colorectal Cancer Screening (CRC) in a Veteran Population: Is It Being Used Appropriately?

Introduction: FIT is one option for CRC screening in average risk patients. FIT has superior performance characteristics compared to older guaiac-based Hemoccult II cards. When utilized appropriately, FIT has a sensitivity and specificity for cancer detection of 94% and 87.5%, respectively (Am J Gastro 2006; Ann Intern Med 2007). Aim: To evaluate if FIT is being utilized appropriately for screening in a veteran population. Methods: EMR reviewed of ninety consecutive veterans with FIT positive tests referred to GI between September 2015 & February 2016, to ascertain: 1) appropriateness of FIT testing, 2) patient understanding and significance of a positive result, 3) prior colonoscopy performed within ten years, 4) history of adenoma or colon cancer & 5) proper collection of FIT specimen. Patients who refused colonoscopy were called. FIT was deemed appropriate when performed in average risk patients as initial screening test for CRC. Results: Median age of patient was 67 +/- SD 9.6. 86 were male, 4 were female. Conclusion: In over 50 % of our veteran population who tested positive, FIT utilization was inappropriate. Similar inappropriate use of FOBT among veterans has been previously shown (Am J Gastro 2006). Better education of primary care providers (PCP's) and patients is necessary before implementation of new tests in order to ensure appropriate & cost effective screening and utilization of resources. Based on our results, we are undertaking an educational initiative for primary care providers.Table 1Table 2

Diagnosing colorectal cancer and inflammatory bowel disease in primary care: The usefulness of tests for faecal haemoglobin, faecal calprotectin, anaemia and iron deficiency. A prospective study

Objective: Abdominal complaints are common reasons to consult primary care but they are seldom caused by colorectal cancer (CRC), high-risk adenomas (HRAs), or inflammatory bowel disease (IBD). Reliable diagnostic aids would be helpful in deciding which patients to refer for bowel imaging. Our aim was to assess the value of a faecal immunochemical test (FIT) and a faecal calprotectin (FC) test in detecting CRC, HRAs and IBD in primary care, and the value of combining these tests with anaemia and iron-deficiency tests.Materials and methods: This prospective study included 373 consecutive patients that received a FIT or a FC test ordered by a primary care physician. We collected samples for FITs, FC tests, full blood counts and iron-deficiency tests. Physicians were instructed to refer patients with a positive FIT or FC test (cut-off ≥100μg/g) for bowel imaging. The patients’ presenting symptoms were recorded. Patients were followed for 2 years.Results: The best test for detecting CRC and IBD was the combination of the FIT and haemoglobin concentration. This test had a sensitivity, specificity, positive predictive value and negative predictive value of 100%, 61.7%, 11.7% and 100%, respectively. The FIT detected a significantly larger proportion of CRC, HRAs and IBD than the FC test (0.92 versus 0.46, 95% confidence interval 0.22–0.67).Conclusion: A negative FIT combined with a normal haemoglobin concentration could rule out CRC and IBD with a high degree of safety. This could be useful in prioritising referrals for bowel imaging from primary care.

Abstract 4338: Advanced neoplasia detection in colorectal cancer screening using multiple stool DNA markers and haemoglobin

Abstract Purpose of the study: Molecular tests have the potential to improve current non-invasive faecal immunochemical test (FIT) screening for colorectal cancer (CRC) and advanced precancerous lesions. We examined the performance of a panel of faecal DNA (sDNA) markers and FIT in archival samples from an invitational CRC screening population. Methods: Whole stool samples were prospectively collected from individuals participating an invitational primary colonoscopy-screening program (COCOS trial). Only participants that provided stool, performed FIT (OC-Sensor) and underwent colonoscopy were selected. The sDNA panel included quantitative molecular assays for KRAS mutations and for aberrant NDRG4 and BMP3 methylation. The performance of the sDNA plus FIT panel was compared to the FIT results alone, by Receiver Operator Characteristic (ROC) analyses. Results: A total of 1047 individuals (51% male) with a median age of 60 years (range 50-75) were included, of which 7 (0.7%) had colorectal cancer and 104 (9.9%) had advanced precancerous lesions (advanced adenomas or sessile serrated polyps ≥ 1 cm). The combination of sDNA and FIT was more sensitive than FIT alone for detecting advanced precancerous lesions (49% (50/102) and 25% (26/102), respectively). Specificities among individuals with non-advanced or negative findings (controls) were 89% and 96% for sDNA and FIT testing, respectively. ROC analysis of CRC and advanced precancerous lesions compared to controls revealed an Area Under the Curve (AUC) of 0.75 for the sDNA plus FIT test, compared to 0.68 for FIT alone. At an equal specificity of 95%, advanced precancerous lesions were detected with a higher sensitivity by the sDNA plus FIT test compared to FIT alone (36% vs 28%, p = 0.08). Conclusions: In an invitational colorectal cancer screening cohort, combining stool DNA markers with FIT detected more advanced neoplasia than FIT alone, primarily due to detecting more advanced adenomas. Citation Format: Linda J.W. Bosch, Veerle Melotte, Sandra Mongera, Kathleen L.J. Daenen, Veerle H.M. Coupe, Sietze T. van Turenhout, Esther M. Stoop, Thomas R. de Wijkerslooth, Chris J.J. Mulder, Ernst J. Kuipers, Evelien Dekker, Michael Domanico, Graham P. Lidgard, Barry M. Berger, Beatriz Carvalho, Manon van Engeland, Gerrit A. Meijer. Advanced neoplasia detection in colorectal cancer screening using multiple stool DNA markers and haemoglobin. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4338.

Abstract 1563: Stool proteomics reveals novel candidate biomarkers for colorectal cancer screening

Abstract Introduction and objectives: Early detection of colorectal cancer (CRC) and its precursor lesions is an effective approach to reduce CRC mortality rates. The fecal immunochemical test (FIT) is a non-invasive CRC screening test that detects small traces of the blood protein hemoglobin. Although beneficial in its current form, the FIT test characteristics leave room for improvement. The aim of the present study was to identify and validate novel protein biomarkers in stool that complement or outperform the current hemoglobin-based test, to improve its diagnostic accuracy. Methods: Proteins isolated from stool from 10 subjects without any signs of colorectal neoplasia (controls) at colonoscopy and from 12 CRC patients were analyzed by GeLC-MS/MS (discovery set). Data were analyzed by comparing protein abundancies, measured as spectral counts. Analysis of differential proteins was performed using the beta-binomial test. Findings were validated by mass spectrometry (Q-Exactive) in an independent series of 292 stool samples obtained from control subjects (n = 109) and subjects with adenomas (n = 55), advanced adenomas (n = 53), or CRCs (n = 75). Results and Discussion: In total 830 human proteins were identified in the discovery set, of which 134 were significantly enriched in CRC. These included 78 proteins that were significantly more enriched in FIT-negative CRC stool samples compared to controls. Preliminary analysis of the validation set indicates that more than half of these markers are significantly more abundant in CRC samples compared to controls. Conclusion: Proteome profiling of stool samples revealed novel candidate biomarkers to improve current CRC screening tests. More data analysis is currently ongoing to select most promising protein biomarkers for clinical assay development. Citation Format: Linda JW Bosch, Meike de Wit, Annemieke C. Hiemstra, Sander Piersma, Thang Pham, Gideon Oudgenoeg, George Scheffer, Sandra Mongera, Malgorzata Komor, Jochim Terhaar Sive Droste, Frank A. Oort, Sietze van Turenhout, Ilhame Ben Larbi, Chris JJ Mulder, Beatriz Carvalho, Remond JA Fijneman, Connie Jimenez, Gerrit A. Meijer. Stool proteomics reveals novel candidate biomarkers for colorectal cancer screening. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1563. doi:10.1158/1538-7445.AM2015-1563

OC-098 Faecal immunochemical testing for haemoglobin in symptomatic patients can help decide need for colonoscopy

Introduction Colonoscopy is an invasive test with associated risks and the majority performed in our NHS Trust are not associated with serious pathology. We aimed to determine whether colorectal cancer could be excluded, and colonoscopy resources better utilised, using faecal haemoglobin concentration (f-Hb) measurements to triage patients presenting in primary care with lower abdominal symptoms. Method Patients referred from primary care to NHS Lanarkshire with colorectal symptoms, who were vetted straight to test for colonoscopy, were asked to participate. Patients were asked to complete a single faecal immunochemical test (FIT) for f-Hb measurement prior to colonoscopy. F-Hb levels were then correlated with colonoscopic and histopathological findings. Results This was a diagnostic accuracy study. From 909 invited patients, 507 patients completed a FIT test. Four hundred and eighty four (484) of them had a colonoscopy. Findings at colonoscopy revealed a total of 45 cases (9.3%) with significant pathology (11 colorectal cancers, 19 high-risk adenomas, 3 inflammatory bowel disease and 12 other colitides). These had a significantly higher (p When a f-Hb cut-off of 10 µg Hb/g faeces is used the sensitivity was 68.9% (95% CI: 53.2–81.4) with a specificity of 80.2% (95% CI: 76.1–83.7). The negative predictive value was particularly high at 96.2% (95% CI: 93.5–97.8) with a positive predictive value of 26.3% (95% CI: 18.8–35.3). Of the 243 with normal colonoscopies, 81.2% had f-Hb Conclusion Considerable potential exists with using f-Hb measurements to assist with triaging symptomatic patients within in a clinical pathway, to either colonoscopy or clinic assessment. This is particularly true with the high negative predictive value of f-Hb suggesting that it can rule out colorectal cancer and other significant colorectal disease with a negative test. No cases of colorectal cancer, in our population, would be missed when using a f-Hb level of Disclosure of interest None Declared.

PTH-146 Optimising the Screening Strategy to Reduce Interval Cancers – Initial Experience in the Welsh Bowel Screening Programme

IntroductionAnalysis of interval bowel cancer rates within two years of a negative screening test kit result demonstrates rates twice as high following an equivocal FOB (Faecal Occult Blood test) with...

Yield of Fecal Immunochemical Test in Detection of Colorectal Cancer and Advanced Neoplasia in Veteran Population at Dayton VA Medical Center

Purpose: Fecal occult blood test (FOBT) is a widely accepted, non-invasive technique for colorectal cancer (CRC) screening. According to national VA directive, a diagnostic colonoscopy must be performed within 60 days of the positive FOBT test. Since May 2009, the Dayton VAMC has replaced the guaiac-based fecal occult blood test (gFOBT) with fecal immunochemical test (FIT) using a cut-off of 100 mg/ml hemoglobin. Aim: To compare the yield of gFOBT versus FIT in the detection of CRC and advanced neoplasia (AN) in average risk veterans at Dayton VAMC and to determine compliance with a follow-up colonoscopy within 60 days of a positive test. Methods: We performed a retrospective chart review of all patients referred for follow-up colonoscopy after a positive FOBT screening test at Dayton VAMC between February 2008 and September 2010. Results: During the study period a total of 351 FOBT (171 gFOBT and 180 FIT) positive subjects were referred for colonoscopy. A total of 65% (229/351) patients completed a colonoscopy, 71% (122/171) with positive gFOBT and 59% (107/180) with positive FIT. Median interval between positive FOBT and colonoscopy was 74 days (Range 1-846 days). Colonoscopy was completed within 60 and 90 days of a positive test in 28% (65/229) and 66% (152/229) subjects, respectively. There were 96% males with median age of 62 years (Range 38-90 years) at the time of positive FOBT. Positive colonoscopy findings (hemorrhoids, diverticuli, polyps, AVMs, mass, inflammation, ischemia) noted in 80% (97/122) gFOBT vs. 88% (94/107) FIT group (p=0.11). The prevalence of AN was 19% (23/122) in gFOBT vs. 23% (25/107) in FIT group. Prevalence of AN in single positive gFOBT was 12% (8/69) vs. 13% (8/61) in FIT group. AN in gFOBT group was located proximal and distal to the splenic flexure in 22% (5/23) and 35% (8/23), respectively. In FIT group, AN was located proximal and distal to the splenic flexure in 12% (3/25) and 32% (8/25), respectively. Synchronous proximal and distal AN was noted in 44% (10/23) gFOBT vs. 56% (14/25) FIT group. CRC was diagnosed in 4% (8/229) patients with median age of 72 years (Range: 55-85 years) at diagnosis. Six cancers were distal and two proximal to the splenic flexure. Prevalence of invasive CRC was 5% (6/122) in gFOBT vs. 2% (2/107) in FIT group (p=0.28). Prevalence of adenomas 10 mm or more in size was 27% (17/63) in gFOBT vs. 35% (21/60) in FIT group (p=0.44). Conclusion: The prevalence of AN was higher in the FIT compared to the gFOBT group, possibly indicating that the FIT test might be more sensitive for detecting earlier stages of neoplasia. Less than one third of the subjects completed a colonoscopy within 60 days of a positive test, indicating need to improve compliance with follow-up colonoscopy.

Mailed Fecal Immunochemical Tests Plus Educational Materials to Improve Colon Cancer Screening Rates in Iowa Research Network (IRENE) Practices

Only about half of all eligible Americans have been screened for colorectal cancer (CRC). The objective of this study was to test whether mailed educational materials and a fecal immunochemical test (FIT), with or without a scripted telephone reminder, led to FIT testing. In addition, we compared changes in attitudes toward, readiness for, and barriers to screening from baseline to follow-up after education about screening. Subjects due for CRC screening were recruited from 16 Iowa Research Network family physician offices. Half of the subjects were randomized to receive mailed written and DVD educational materials, along with a FIT, either with or without a telephone call designed to encourage screening and address barriers. Subjects completed surveys regarding their attitudes and readiness for CRC screening at baseline and after education about screening. The main outcome was whether the subject completed FIT testing. A total of 373 individuals received educational materials (including a FIT) and 231 (62%) returned a posteducation survey. The mean age was 61.2 years; 52% were women, 99% were white, 39% had a high school education or less, 39% had a total family income of less than $40,000, and 7% had no insurance. The written materials were read by 82%, understood by 91% (of those who read them), and 82% felt their knowledge was increased. The DVD was viewed by 67%, understood by 94% of those who viewed it, and 86% felt the DVD increased their knowledge. Compared with baseline, individuals reported being significantly more likely to bring up CRC screening at their next doctor's visit (P < .0001) and being more likely to be tested for CRC in the next 6 months (P < .0001). Comparing baseline with follow-up, summary attitude scores improved (P < .0001), readiness scores improved (P < .0001), and there were fewer barriers (P = .034, Wilcoxon signed rank). The FIT return rate increased from 0% to 45.2% in the education alone group and from 0% to 48.7% for the group receiving education plus the telephone call (P < .0001 for each group individually and overall when compared with Medicare beneficiaries in Iowa). Mailing FIT kits with easy-to-understand educational materials improved attitudes toward screening and dramatically increased CRC screening rates among patients who were due for screening in a practice-based research network. A telephone call addressing barriers to screening did not result in increased FIT testing compared with mailed education alone.

Colorectal Cancer Screening for Average-Risk North Americans: An Economic Evaluation

Colorectal cancer (CRC) fulfills the World Health Organization criteria for mass screening, but screening uptake is low in most countries. CRC screening is resource intensive, and it is unclear if an optimal strategy exists. The objective of this study was to perform an economic evaluation of CRC screening in average risk North American individuals considering all relevant screening modalities and current CRC treatment costs. An incremental cost-utility analysis using a Markov model was performed comparing guaiac-based fecal occult blood test (FOBT) or fecal immunochemical test (FIT) annually, fecal DNA every 3 years, flexible sigmoidoscopy or computed tomographic colonography every 5 years, and colonoscopy every 10 years. All strategies were also compared to a no screening natural history arm. Given that different FIT assays and collection methods have been previously tested, three distinct FIT testing strategies were considered, on the basis of studies that have reported "low," "mid," and "high" test performance characteristics for detecting adenomas and CRC. Adenoma and CRC prevalence rates were based on a recent systematic review whereas screening adherence, test performance, and CRC treatment costs were based on publicly available data. The outcome measures included lifetime costs, number of cancers, cancer-related deaths, quality-adjusted life-years gained, and incremental cost-utility ratios. Sensitivity and scenario analyses were performed. Annual FIT, assuming mid-range testing characteristics, was more effective and less costly compared to all strategies (including no screening) except FIT-high. Among the lifetimes of 100,000 average-risk patients, the number of cancers could be reduced from 4,857 to 1,393 [corrected] and the number of CRC deaths from 1,782 [corrected] to 457, while saving CAN$68 per person. Although screening patients with FIT became more expensive than a strategy of no screening when the test performance of FIT was reduced, or the cost of managing CRC was lowered (e.g., for jurisdictions that do not fund expensive biologic chemotherapeutic regimens), CRC screening with FIT remained economically attractive. CRC screening with FIT reduces the risk of CRC and CRC-related deaths, and lowers health care costs in comparison to no screening and to other existing screening strategies. Health policy decision makers should consider prioritizing funding for CRC screening using FIT.

931 Attendance and Diagnostic Yield of One Versus Two-Sample Fecal Immunochemical Test (FIT) Screening; a Comparative Population-Based Colorectal Cancer Trial

Background Fecal Immunochemical Tests (FITs) are widely used for Colorectal Cancer (CRC) screening. Some sampling schemes use one-day FIT testing, whereas others use twoday FIT testing. Data on sensitivity and specificity of two-day FIT testing are lacking. This study aims to compare the difference in sensitivity and specificity of three different strategies of two-day FIT sampling, at different cut-off values. Methods In three hospitals in the Amsterdam area, all subjects ≥18 years who were referred for elective colonoscopy were asked to perform a FIT (OC sensor®) on two consecutive days. Colonoscopy and histology were considered as gold standard. Two-day FIT sampling was defined positive in three different ways: 1) when at least one of two FITs was above the cut-off value (FIT+), 2) when both FITs were above the cut-off value(FIT++), and 3) when the geometric mean of two FITs was above the cut-off value (FITmean). Test performance of all three strategies was evaluated at cut-off values of 50, 75 and 100ng/ml. Results In 1105 subjects with complete colonoscopy, 140 (9,4%) AN were found (34 CRCs and 106 advanced adenomas). Of the CRC cases, 70% were Dukes stage A or B (stage unknown in 2). Positivity rates for FIT+ ranged from 16-23%, for FIT++ from 10-13% and for FITmean from 13-17% (see table). At any cut-off level, FIT++ resulted in the lowest and FIT+ in the highest sensitivity. FIT++ showed a higher specificity than both other strategies (see table). Conclusions The most sensitive strategy in two-day FIT sampling is defining the test positive when at least one of both FITs passes the cut off (FIT+), whereas the highest specificity is obtained when both FITs need to be positive for calling the tests positive (FIT++). At all cut-off values, FITmean offers substantially better specificity than FIT+, while sensitivity is substantially higher than FIT++. Sensitivity and specificity of three methods to use two-day FIT sampling for the detection of advanced neoplasia

Practical Advances in Stool Screening for Colorectal Cancer

The rationale for screening for colorectal cancer (CRC) is well established, and several tests are currently recommended. Colonoscopy has become a popular modality in most of the United States and other countries. Despite colonoscopy being highly accurate and therapeutic, many patients prefer a noninvasive screening test. Testing stool for occult blood by the chemical guaiac reagent (gFOBT) has been available for decades and is effective at reducing mortality from CRC. However, because of limitations in sensitivity and specificity, newer fecal immunochemical tests (FITs) were developed that detect occult blood using enzyme immunoassays. Because of their improved sensitivity and specificity, FITs have replaced gFOBT for screening in many settings. Detecting neoplasia-associated genetic changes in stool has also become feasible; first-generation stool DNA tests showed greater sensitivity for CRC, with similar specificity to gFOBT. Improvements to stool DNA tests have made them more sensitive and less complex. As the performance characteristics for FIT and stool DNA tests continue to evolve, stool-based testing for CRC is expected to become a more reliable component in the armamentarium for CRC screening.