Faecal Immunological Test Research Articles

Precision Colorectal Cancer Fecal Immunological Test Screening With Fecal-Hemoglobin-Concentration–Guided Interscreening Intervals

Given a gradient relationship between fecal hemoglobin (f-Hb) concentration and colorectal neoplasia demonstrated previously, using f-Hb-guided interscreening interval has increasingly gained attention in population-based fecal immunological test (FIT), but it is very rare to address how to implement such a precision strategy and whether it can economize the use of FIT and colonoscopy. To demonstrate the applicability of personalized colorectal cancer (CRC) screening with f-Hb-guided screening intervals to reduce the number of FITs and colonoscopy with as equivalent efficacy as universal biennial screening. A retrospective cohort study for developing f-Hb-guided precision interscreening interval was conducted using data on a Taiwanese biennial nationwide FIT screening program that enrolled more than 3 million participants aged 50 to 74 years between 2004 and 2014. The cohort was followed up over time until 2019 to ascertain colorectal neoplasia and causes of death. A comparative study was further designed to compare the use of FIT and colonoscopy between the personalized f-Hb-guided group and the universal biennial screening group given the equivalent efficacy of reducing CRC-related outcomes. A spectrum of f-Hb-guided intervals was determined by using the Poisson regression model given the equivalent efficacy of a universal biennial screening. The use of FIT and colonoscopy for the pragmatic f-Hb-guided interval group was measured compared with the universal biennial screening group. Data analysis was performed from September 2022 to October 2023. Using data from the 3 500 250 participants (mean [SD] age, 57.8 [6.0] years) enrolled in the Taiwanese biennial nationwide FIT screening program, an incremental increase in baseline f-Hb associated with colorectal neoplasia and CRC mortality consistently was observed. Participants with different f-Hb levels were classified into distinct risk categories. Various screening intervals by different f-Hb levels were recommended. Using the proposed f-Hb-guided screening intervals, it was found that the personalized method was imputed to reduce the number of FIT tests and colonoscopies by 49% and 28%, respectively, compared with the universal biennial screening. The gradient relationship between f-Hb and colorectal neoplasia and CRC mortality was used to develop personalized FIT screening with f-Hb-guided screening intervals. Such a precision interscreening interval led to the reduced use of FIT test and colonoscopy without compromising the effectiveness of universal biennial screening.

Assessing overdiagnosis of fecal immunological test screening for colorectal cancer with a digital twin approach

Evaluating the magnitude of overdiagnosis associated with stool-based service screening for colorectal cancer (CRC) beyond a randomized controlled trial is often intractable and understudied. We aim to estimate the proportion of overdiagnosis in population-based service screening programs for CRC with the fecal immunochemical test (FIT). The natural process of overdiagnosis-embedded disease was first built up to learn transition parameters that quantify the pathway of non-progressive and progressive screen-detected cases calibrated with sensitivity, while also taking competing mortality into account. The Markov algorithms were then developed for estimating these transition parameters based on Taiwan FIT service CRC screening data on 5,417,699 residents aged 50–69 years from 2004 to 2014. Following the digital twin design with the parallel universe structure for emulating the randomized controlled trial, the screened twin, mirroring the control group without screening, was virtually recreated by the application of the above-mentioned trained parameters to predict CRC cases containing overdiagnosis. The ratio of the predicted CRCs derived from the screened twin to the observed CRCs of the control group minus 1 was imputed to measure the extent of overdiagnosis. The extent of overdiagnosis for invasive CRCs resulting from FIT screening is 4.16% (95% CI: 2.61–5.78%). The corresponding figure is increased to 9.90% (95% CI: 8.41–11.42%) for including high grade dysplasia (HGD) and further inflated to 15.83% (95% CI: 15.23–16.46%) when the removal adenoma is considered. The modest proportion of overdiagnosis modelled by the digital twin method, dispensing with the randomized controlled trial design, suggests the harm done to population-based FIT service screening is negligible.

OP23 Asymptomatic inflammatory bowel disease diagnosed during the colorectal cancer population screening in Catalonia

Abstract Background Background: It has been postulated that early treatment of inflammatory bowel disease (IBD) is associated with a better long-term response. In Catalonia, the early detection program for colorectal cancer (EDPCRC) has been active since 2010, and was extended to the entire Catalan territory in 2015. The aim of this study is to describe the natural history of IBD asymptomatic diagnosed through the EDPCRC in Catalonia. Methods Methods: Observational, longitudinal and retrospective study of patients with IBD detected in the EDPCRC with a positive faecal immunological test in 21 centers in Catalonia between 2010 and 2019. Data was collected from the clinical histories. Results Results: 237 patients were identified; 35 patients had symptoms before endoscopy and were excluded from the study, finally 200 patients were diagnosed with asymptomatic IBD during the EDPCRC; 109 ulcerative colitis (54.5%), 63 Crohn’s disease (31.5%) and 28 unclassifiable colitis (14%). 35.5% were women (n=71) with an average age of 60 years (range 49-79). Of the asymptomatic, 40.5% developed symptoms (n=81), being diarrhea the most frequent (n=45; 55.6%). The median time to first symptom was 368 days. Treatment was prescribed in 74.5% (n=149) of the patients. Mesalazine was the most frequently prescribed drug (n=130). The main reason for prescribing it was endoscopic activity (n=107), followed by the appearance of symptoms (n=39) and the biochemical activity (n=9). Only 19 patients (9.5%) required biological treatment (5 infliximab, 10 adalimumab, 2 vedolizumab and 2 ustekinumab). 4 patients (2%) required surgery. Conclusion Conclusion: Less than half of patients diagnosed with IBD at a preclinical stage develop symptoms after the first year of follow-up. Only 9.5% require biological treatment and 2% surgery. Three-quarters of patients are prescribed treatment; the most used was mesalazine.

Perceived Importance of the Benefits and Harms of Colorectal Cancer Screening: A Best-Worst Scaling Study

ObjectivesTo elicit the relative importance of the benefits and harms of colorectal cancer (CRC) screening among potential screening participants in the Dutch population. MethodsIn a consensus meeting with 11 experts, risk reduction of CRC and CRC deaths (benefits) and complications from colonoscopy, stress of receiving positive fecal immunological test (FIT) results, as well as false-positive and false-negative FIT results (harms) were selected as determinant end points to consider during decision making. We conducted an online best-worst scaling survey among adults aged 55 to 75 years from the Dutch Health Care Consumer Panel of The Netherlands Institute for Health Services Research to elicit preference values for these outcomes. The preference values were estimated using conditional logit regression. ResultsOf 265 participants, 234 (89%) had ever participated in CRC screening. Compared with the stress of receiving a positive FIT result, the outcome perceived most important was the risk of CRC death (odds ratio [OR] 4.5; 95% confidence interval [CI] 3.9-5.1), followed by risk of CRC (OR 4.1; 95% CI 3.6-4.7), a false-negative FIT result (OR 3.1; 95% CI 2.7-3.5), colonoscopy complications (OR 1.6; 95% CI 1.4-1.8), and a false-positive FIT result (OR 1.4; 95% CI 1.3-1.6). The magnitude of these differences in perceived importance varied according to age, educational level, ethnic background, and whether the individual had previously participated in CRC screening. ConclusionDutch men and women eligible for FIT-based CRC screening perceive the benefits of screening to be more important than the harms.

Intention to probe into the colonoscopy trial: Is it the procedure or the trial that failed?

The NordICC trial published recently provides the first randomized evidence on the effectiveness of colonoscopy-based colorectal cancer (CRC) screening.1 Although alternative means of CRC screening with evidence from randomized trials are available, such as flexible sigmoidoscopy or non-invasive fecal occult blood testing (FOBT) or fecal immunological test (FIT), physicians and organizations- specifically in the U.S- have been making strong recommendations for colonoscopy screening based on extrapolation of data from sigmoidoscopy trials and the NordICC trial has created a controversy on whether that is appropriate.

Premier bilan du programme vaudois de dépistage du cancer colorectal

The Vaud colorectal cancer (CRC) screening program, pioneer in Switzerland, offers since 2015 the choice between a biennial fecal immunological test (FIT) and a colonoscopy every 10 years to those aged 50 to 69. This first epidemiological evaluation of a Swiss CRC screening program shows an increasing uptake over the years and an equal distribution of choice of tests, but with regional differences. Quality of both FIT and colonoscopy fulfil the European norms. The high proportion of early-stage cancers (60% stage I) met expectations. The large increase in screening tests and limited colonoscopy capacity is leading to interprofessional discussions on strategies for prioritizing FIT, accompanied by additional orientation tools within the program and public sensitization, and for reducing the time taken to perform FIT positive colonoscopies.

Low potency of fecal immunological surveillance testing soon after negative colonoscopy or resection of low-risk adenoma in average-risk patients.

Postcolonoscopy surveillance colonoscopy based on positive fecal occult blood testing (FOBT) is often performed, although its long-term efficacy has not been established. The aim of this study was to clarify the low potency of FOBT surveillance at short intervals after colonoscopy. Colonoscopy was performed in 1308 average-risk patients, based on positive results of immunological FOBT [fecal immunological test (FIT)]. Patients were stratified according to the length of time since their last colonoscopy and their colonoscopy results [no adenoma or 1-2 small (<10 mm) adenomas]. Tumor detection rates were determined. The baseline patients characteristics did not differ between the groups. The advanced lesion detection rate (ALDR) among the patients who had never undergone a colonoscopy was 21.9% [95% confidence interval (CI), 19.1-25.0%]. Among the patients who had no adenoma detected in the previous colonoscopy within the past 5 years, the past 5-10 years and over 10 years, the ALDRs were 2.5% (95% CI, 1.0-5.5%), 4.1% (95% CI, 1.5-9.4%) and 9.3% (95% CI, 3.1-22.2%), respectively. Among the patients who had 1-2 small adenomas, the ALDRs were 7.4% (95% CI, 3.4-14.8%), 12.1% (95% CI, 4.2-27.9%) and 27.8% (95% CI, 12.2-51.2%), respectively. Invasive cancer was not observed in any patients within 5 years since the prior colonoscopy. In average-risk patients whose prior colonoscopy detected no adenomas or low-risk adenomas, postcolonoscopy surveillance by FIT has a low positive predictive value within a 5-year interval.

Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic.

Background: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs. Resuming these programs is a priority, but fewer colonoscopies may be available. We developed an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC.Methods: We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/2018. We investigated two different scenarios: not modifying vs. modifying the FIT cut-off value. We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed).Results: The current FIT cut-off (20-μg hemoglobin/g feces) led to 6,606 colonoscopies per 100,000 people invited annually. Without modifying this FIT cut-off value, when the optimal number of individuals invited for colonoscopies was reduced by 10–40%, a high number of CRCs and high-risk adenomas (34–135 and 73–288/100.000-people invited, respectively) will be undetected every year. When the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability, the number of missed lesions per year was remarkably reduced (9–36 and 29–145/100.000 people, respectively). Moreover, the unmodified FIT scenario outcome was improved by prioritizing the selection process based on sex (males) and age, rather than randomly reducing the number invited.Conclusions: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors to prioritize access to colonoscopies should be also considered.

Optimal cut-off value for detecting colorectal cancer with fecal immunochemical tests according to age and sex.

In the fecal immunological test, a suitable cut-off value may be selected to classify results as either positive or negative. Our aim is to estimate the optimal cut-off value for detecting colorectal cancer in different age and sex groups. This is a multicentric retrospective cohort study of participants in CRC screening programs with FIT between 2006 and 2012. A total of 545,505 participations were analyzed. Cancers diagnosed outside of the program were identified after a negative test result (IC_test) up until 2014. The Wilcoxon test was used to compare fecal hemoglobin levels. ROC curves were used to identify the optimal cut-off value for each age and sex group. Screening program results were estimated for different cut-off values. The results show that the Hb concentration was higher in colorectal cancer (average = 179.6μg/g) vs. false positives (average = 55.2μg/g), in IC_test (average = 3.1μg/g) vs. true negatives (average = 0μg/g), and in men (average = 166.2μg/g) vs. women (average = 140.2μg/g) with colorectal cancer. The optimal cut-off values for women were 18.3μg/g (50-59y) and 14.6μg/g (60-69y), and 16.8μg/g (50-59y) and 19.9μg/g (60-69y) for men. Using different cut-off values for each age and sex group lead to a decrease in the IC_test rate compared to the 20μg/g cut-off value (from 0.40‰ to 0.37‰) and an increase in the false positive rate (from 6.45% to 6.99%). Moreover, test sensitivity improved (90.7%), especially in men and women aged 50-59y (89.4%; 90%) and women aged 60-69y (90.2%). In conclusion, the optimal cut-off value varies for different sex and age groups and the use of an optimal cut-off value for each group improves sensitivity and leads to a small decrease in IC_tests, but also to a larger increase in false positives.

Sensitive detection of colorectal cancer in peripheral blood by a novel methylation assay

BackgroundColorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. Early detection of CRC can significantly reduce its mortality rate. Current method of CRC diagnosis relies on the invasive endoscopy. Non-invasive assays including fecal occult blood testing (FOBT) and fecal immunological test (FIT) are compromised by low sensitivity and specificity, especially at early stages. Thus, a non-invasive and accurate approach for CRC screening would be highly desirable.ResultsA new qPCR-based assay combining the simultaneous detection of the DNA methylation status of ten candidate genes was used to examine plasma samples from 56 normal controls, 6 hyperplastic polys, 9 non-advanced adenomas (NAAs), 22 advanced adenomas (AAs) and 175 CRC patients, using 10 ng of cfDNA. We further built a logistic regression model for CRC diagnosis. We tested ten candidate methylation markers including twist1, vav3-as1, fbn1, c9orf50, sfmbt2, kcnq5, fam72c, itga4, kcnj12 and znf132. All markers showed moderate diagnostic performance with AUCs ranging from 0.726 to 0.815. Moreover, a 4-marker model, comprised of two previously reported markers (c9orf50 and twist1) and two novel ones (kcnj12 and znf132), demonstrated high performance for detecting colorectal cancer in an independent validation set (N = 69) with an overall AUC of 0.911 [95% confidence interval (CI) 0.834–0.988], sensitivity of 0.800 [95% CI 0.667–0.933] and specificity of 0.971 [95% CI 0.914–1.000]. The stage-stratified sensitivity of the model was 0.455 [95% CI 0.227–0.682], 0.667 [95% CI 0.289–1.000], 0.800 [95% CI 0.449–1.000], 0.800 [95% CI 0.449–1.000] and 0.842 [95% CI 0.678–1.000] for advanced adenoma and CRC stage I-IV, respectively.Conclusionkcnj12 and znf132 are two novel methylation biomarkers for CRC diagnosis. The 4-marker methylation model provides a new non-invasive choice for CRC screening and interception.

Colorectal cancer screening programme: is the French faecal immunological test (FIT) threshold optimal?

Background:In France, the colorectal cancer organised screening programme uses the faecal immunological test. A positive test ⩾30 μg Hb/g of stool leads to a colonoscopy for identification of potential colorectal lesions. Cut-off values vary from 20 to 47 μg Hb/g of stool in Western countries. We herein question this threshold’s relevance in a French population and perform a retrospective observational study using the Parisian database between 1 April 2015 and 31 December 2018.Methods:Rates of participation, numbers of positive faecal immunological test (FIT), detection rates and positive predictive values for advanced adenomas and/or colorectal cancer were determined. Mean positivity values for colorectal lesions were calculated.Results:In our population, there were 4.1% positive tests and 67.6% colonoscopy results available with final reports. Positive predictive value for advanced adenomas and colorectal cancer were 30% [95% confidence interval (CI) 29.8–30.3] and 7.4% (95% CI 7.35–7.52), respectively. The mean positivity value for all positive tests in our population was 101.7 µg Hb/g of stool (95% CI 85–118.3). There were 1136 normal colonoscopies (21.4%) with a mean positivity value of 88.6 μg Hb/g of stool. Following a negative test in a first screening campaign, 40.8% of patients in our population performed a second test with a positivity rate of 1.3% and with the encounter of 81 colorectal cancers. The risk of having a positive test during the second screening campaign and finding advanced colorectal lesions significantly increased (all p < 0.001) when comparing negative FIT results ranging between 15 and 29 μg Hb/g of stool to 0 and 14 μg Hb/g of stool from the previous campaign.Conclusion:Using the current positivity threshold, some patients were considered negative with a delay in colorectal cancer diagnosis, suggesting the threshold could be lowered. Also, the mean positivity value for normal colonoscopies was high, raising the question of upper gastrointestinal bleeding.

The impact of increasing multitarget stool DNA use among colorectal cancer screeners in a self-insured US employer population

ABSTRACT Background: In the United States (US), colorectal cancer (CRC) is the second leading cause of cancer-related deaths. With the majority of the US population covered by employer-based health plans, employers can play a critical role in increasing CRC screening adherence, which may help avert CRC-related deaths. Therefore, it is important for self-insured employers to consider the impact of appropriate utilization of CRC screening options. Objective: To evaluate the impact of increasing multitarget stool DNA [mt-sDNA (Cologuard®)] use among CRC screeners from the perspective of a US self-insured employer. Methods:A 5-year Markov model was developed to quantify the budget impact of increasing mt-sDNA from 6% to 15% among average-risk screeners using colonoscopy, fecal immunological test, and mt-sDNA. Data on direct medical costs were obtained from published literature, Medicare CPT codes, and the Healthcare cost and Utilization project. Indirect costs included productivity loss due to workplace absenteeism for CRC screening and treatment. Results: With a hypothetical population of 100,000 employees with screeners aged 50–64 years, compared to status quo, increased mt-sDNA utilization resulted in no differences in the numbers of cancers detected and the overall direct and indirect cost savings were ~$214,000 ($0.04 per-employee-per-month) over 5 years. Most of the savings were due to a reduction in the direct medical expenditure related to CRC screening, adverse events, and productivity loss due to colonoscopy screening. Similar results were observed in the model simulation among screeners aged 45–64 years. Conclusion: Increased utilization of mt-sDNA for CRC screening averts direct and indirect medical costs from a self-insured US employer perspective.

Comparative evaluation of two colorectal cancer screening campaigns using different faecal occult blood tests in a French area

ObjectiveThe aim of this study was to compare quality performance of the first colorectal cancer (CRC) screening campaigns (C) with the OC Sensor® Faecal Immunological Test (FIT) (C7 from 2016 to 2017) and the Hemoccult® guaiac-based test (C1 from 2004 to 2006). MethodsThe participation rate of the eligible population, screening fecal occult blood test (FOBT) performance indices, CRC and adenoma detection rate and time interval between test positivity and colonoscopy were studied. ResultsIn C7, 35.9 % of the eligible population completed the screening process versus 47.6 % in C1 (p < 0.0001). The positivity rate was of 4.3 % for OC Sensor® FIT and 2.3 % for Hemoccult® test (p < 0.0001). A total of 3,252 colonoscopies were performed in C7 versus 2,005 in C1; 246 CRCs and 1,160 advanced adenomas (AA) were detected in C7 compared to 140 CRCs and 491 AA in C1 (p < 0.0001). The FOBT cancer detection rate increased significantly from 1.4 ‰ to 2.9 ‰ between the two campaigns, as did the FOBT AA detection rate, from 5.7 ‰ to 13.7 ‰. During C7, the mean time for colonoscopy after a positive FIT result was 84.3 days [95 % CI: 77.9–90.7]. There was no significant difference between the stages at diagnosis according to the time for colonoscopy within the first 6 months. ConclusionsCRC and AA detection rates increased significantly between the two campaigns. Longer follow-up will be required to show a potential decrease in the incidence of invasive CRCs.

Elucidating Higher FIT Interval Caners in Proximal than Distal Colon: Population-Based Periodical Screening Cohort Design

Background: The risk of fecal immunological test (FIT) interval cancer (IC) is higher in the proximal colon than the distal colon but the underlying mechanism explaining the disparity remains elusive. Therefore in this study, we aimed to investigate whether the disparity is attributed to FIT accuracy or the fast progression rates from early to late stage (upstaging) within preclinical-detectable phase (PCDP) and from PCDP to clinical phase (CP). Methods: We did a population-based periodical screening cohort study. Data derived from Taiwanese nationwide colorectal cancer (CRC) organized service screening program. A total of 5,417,699 eligible population aged 50-69 with 3,074,538 individuals ever attending until the end of 2014. The incidence rate of entering the PCDP, the upstaging rate within PCDP, the rate of surfacing to CP, and the test sensitivity classified by early (stage 0/I) and late (stage 2+) stage analyzed with the five-state Markov model. Findings: The proportions of ICs (19% vs 16%) and late CRCs (76% vs 67%) were higher in the proximal colon than the distal colon, which was caused by a faster progression rate from PCDP to CP by 19% and a higher likelihood of upstaging in the proximal colon than the distal colon by 1.6-fold, resulting in the corresponding survival difference of IC, but not site-specific FIT accuracy. Interpretation: Faster progression noted in proximal colon not only supports the previous evidence on rapid transition from dysplasia to malignancy for sessile serrated adenomas but also explain the disparity of effectiveness of FIT and provide a new insight into precision medicine for identifying those who are susceptible to the proximal IC of CRC. Funding: None Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This study was approved by the Health Promotion Administration, Ministry of Health and Welfare prior to data retrieval and analysis (A1081113) of Taiwanese government and approved by the Research Ethics Committee of National Taiwan University Hospital prior to data collection pursuant to the regulation of the Institutional Review Board (20192023W).

Prediction of advanced colonic neoplasm in symptomatic patients: a scoring system to prioritize colonoscopy (COLONOFIT study)

BackgroundFast-track colonoscopy to detect patients with colorectal cancer based on high-risk symptoms is associated with low sensitivity and specificity. The aim was to derive a predictive score of advanced colonic neoplasia in symptomatic patients in fast-track programs.MethodsAll patients referred for fast-track colonoscopy were evaluated. Faecal immunological haemoglobin test (3 samples; positive> 4 μg Hb/g), and a survey to register clinical variables of interest were performed. Colorectal cancer and advanced adenoma were considered as advanced colonic neoplasia. A sample size of 600 and 500 individuals were calculated for each phase 1 and phase 2 of the study, respectively (Phase 1, derivation and Phase 2, validation cohort). A Bayesian logistic regression analysis was used to derive a predictive score.Results1495 patients were included. Age (OR, 21), maximum faecal-Hb value (OR, 2.3), and number of positive samples (OR, 28) presented the highest ORs predictive of advanced colonic neoplasia. The additional significant predictive variables adjusted for age and faecal-Hb variables in Phase 1 were previous colonoscopy (last 5 years) and smoking (no, ex/active). With these variables a predictive score of advanced colonic neoplasia was derived. Applied to Phase 2, patients with a Score > 20 had an advanced colonic neoplasia probability of 66% (colorectal cancer, 32%), while those with a Score ≤ 10, a probability of 10% (colorectal cancer, 1%). Prioritizing patients with Score > 10, 49.4% of patients would be referred for fast-track colonoscopy, diagnosing 98.3% of colorectal cancers and 77% of advanced adenomas.ConclusionsA scoring system was derived and validated to prioritize fast-track colonoscopies according to risk, which was efficient, simple, and robust.

Impact de l’intégration du test immunologique dans le programme de dépistage du cancer colorectal en France

While organized screening for colorectal cancer has been extended to the whole of France since 2008, there is no evidence to suggest that this screening based on use of the guaiac test had a significant impact on trends in its incidence and mortality in France in the last 10 years. Following the first prospective trials conducted in Normandy, FIT (Fecal Immunological Test) was proposed to the entire national territory from 2015. Three years after its generalization, it is of course impossible to measure the effects of this modification of strategy on the incidence or mortality from colorectal cancer. However, for both models and data from the ten departments of the Greater East region, this test should make it possible to detect 2.5 more cancers and 3.7 times more advanced adenomas than the guaiac test and sensitivity. A biennial program using an immunoassay should be about 75%. On the other hand, it is reasonable to hope that the technical characteristics of the test and the newfound confidence of the doctors eventually improve the participation of the target population. The result of an improvement in the technical performance of the test and an (expected) increase in participation should ultimately be measurable translation into the general population in terms of improving the survival of people with cancer, lowering the risk of cancer incidence of the most advanced forms and decline in mortality.

Fecal immunological blood test is more appealing than the guaiac-based test for colorectal cancer screening

BackgroundThe reasons for participation in fecal immunological testing (FIT) of subjects who were previously non-respondents to guaiac fecal occult blood testing (g-FOBT) have not been assessed. Population and methodsWe aimed to determine the reasons for current compliance with FIT among non-responders to g-FOBT, termed “converts‿, in a French district. A questionnaire was returned by 170 converts aged from 55 to 75 years (response rate 75.2% after exclusions). ResultsThe major barriers to participation in screening with g-FOBT were test-related: the test was perceived as complicated (24%) and it required three consecutive stools (28%). Among the test-related major determinants of FIT compliance was the perception that the test was less complicated than previous test (30%) and that a unique stool sample was required (29%). Among the non-test related major determinants of FIT compliance were the perception that the general practitioner was more convincing (31%) and the feeling to be more concerned because of age (21%). The reasons for compliance among converts did not differ according to age, sex, and rural or urban residence. ConclusionsOur study demonstrated that the simplicity of FIT and the endorsement of practitioners were both major motivations for FIT compliance among non-respondents in at least two previous consecutive campaigns.

Association between diverticulosis and colonic neoplastic lesions in individuals with a positive faecal immunochemical test.

The association between diverticulosis and colonic neoplastic lesions has been suggested, but data in literature are conflicting. This study aimed to investigate such a relationship in patients participating in a colorectal cancer screening program who underwent high-quality colonoscopy. Data from consecutive individuals 50-75 years of age with a positive faecal immunological test were considered. Diverticulosis was categorised as present or absent. The prevalence of neoplastic lesions (adenoma, advanced adenoma, and cancer) between individuals with and those without diverticula was compared. A multivariate analysis was performed. Overall, data from 970 consecutive individuals were evaluated, and diverticulosis was detected in 354 (36.5%) cases. At least one adenoma was detected in 490 (50.5%) people, at least one advanced adenoma in 264 (27.2%), multiple adenoma in 71 (7.3%), whilst a cancer was diagnosed in 48 (4.9%) cases. At univariate analysis, the adenoma detection rate in patients with diverticula was significantly higher than in controls (55.9% vs 47.4%; p = 0.011). At multivariate analysis, presence of diverticulosis was an independent risk factor for both adenoma detection rate (OR = 1.58; 95% CI = 1.14-2.18; p = 0.006) and advanced adenoma (OR = 1.57; 95% CI = 1.10-2.24; p = 0.013), but not for colorectal cancer. In a colorectal screening setting, the adenoma detection rate was significantly higher in individuals with diverticulosis than in controls.

Sustained participation, colonoscopy uptake and adenoma detection rates over two rounds of the Tallaght–Trinity College colorectal cancer screening programme with the faecal immunological test

Studies to date support the use of the faecal immunological test (FIT) in colorectal cancer screening programmes, and it has been widely adopted across Europe, Canada, Australia, and the USA. Successive screening rounds are necessary to detect and prevent colorectal cancer. The overall success of FIT screening will depend on several factors, the most important probably being the acceptability of repeated screening rounds. Being a newer form of occult blood testing, there is little data available on its overall efficacy over time. The aim of this study was to assess key performance indices during a second round of FIT screening in an Irish cohort and to compare results between successive rounds. A biennial, two tests, two-step design with postal invites and colonoscopy offered to anyone with a single FIT greater than 100 ngHb/ml was used. Recommended key performance measures were assessed and compared, including participation, positivity, colonoscopy uptake and adenoma and cancer detection rates. In round two, 9863 individuals (98.6%) of the round one cohort were contacted. The round two participation rate was 47.5% (n=4685), only slightly lower than the 51% registered in round one. Male sex and younger age were associated with lower uptake. Overall positivity decreased from 10 to 8% over time (P<0.0001). Although the number of cancers detected during round two decreased significantly, overall neoplasia detection rates remained stable; positive predictive values for cancer and adenoma were 4 versus 1% and 37 versus 35%, respectively. Repeated rounds of FIT screening in the Tallaght-Trinity College cohort achieved stable participation and neoplasia detection rates, suggesting that this mode of screening is both effective and acceptable to patients in the long term.

Evaluating a new immunoassay method for fecal occult blood test

Background Local Health Authority (LHA) 7 of Siena has recently adopted a new immunoassay method of fecal occult blood test (FOBT) in the screening of colorectal cancer. This method uses colloidal gold for fecal immunological test (gold-FIT) instead of the latex (latex-FIT). The aims of this study were to compare the positivity rate (PR) and the positive predictive value (PPV) …