scholarly journals O53 Faecal immunochemical testing: cost effective way stratifying symptomatic patients for urgent straight to test investigation

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
J K Seehra ◽  
F Khasawneh ◽  
B Singh
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Secondary Care ◽  
Cost Effective ◽  
Bowel Habit ◽  
Sensor Platform ◽  
Testing Cost ◽  
Immunochemical Test ◽  
The Mean ◽  
Test Investigation

Abstract Introduction Quantitative faecal immunochemical test (FIT) offers the opportunity to stratify symptomatic ‘high risk’ colorectal patients for further investigation. Method FIT was introduced in primary care to stratify ‘high risk’ symptomatic patients aged 60 years and above with a change in bowel habit to determine whether an urgent straight to test (STT) CT colonography (CTC) was indicated. All FIT tests were analysed in a national bowel screening hub using the OC-Sensor platform. A result of ≥ 4 μgHb/gFaeces, was used as the cut-off. All FIT results were cross referenced with a prospectively maintained colorectal cancer registry to determine the colorectal cancer detection rate (CRC). Data was analysed from February 2018-December 2019. Result The mean number of total CTC performed per month pre-FIT was 240 (range 185–278) and reduced to 217 (range 183–264) post-implementation (P < 0.05). The number referred under the STT pathway was 167 (range 119–209) reducing to 131 (range 91–153) (P < 0.05), however there was a corresponding rise in the number of non-STT referrals from outpatients 73 (range 44–105) to 85 (range 60–111) (P < 0.05). Conclusion FIT has the potential to reduce the burden on secondary care investigations to exclude bowel cancer. Our experience has shown that a conservative FIT level of < 4ug/ml has reduced numbers of STT referrals by 22%. Take-home Message FIT can be used for symptomatic patients with a change in bowel habits to stratify the need for further investigations. Post-implementation, FIT has reduced STT referral rates and reduced the burden placed on secondary care.

Colonoscopy later than 270 days in a fecal immunochemical test-based population screening program is associated with higher prevalence of colorectal cancer

Endoscopy ◽  
2020 ◽  
Vol 52 (10) ◽  
pp. 871-876 ◽  
Author(s):  
Manuel Zorzi ◽  
Cesare Hassan ◽  
Giulia Capodaglio ◽  
Maddalena Baracco ◽  
Giulio Antonelli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Screening Program ◽  
Waiting Times ◽  
Multivariable Analysis ◽  
Latex Agglutination ◽  
Old Patients ◽  
Screening Programs ◽  
Increased Risk ◽  
Immunochemical Test

Background Colorectal cancer (CRC) screening programs based on fecal immunochemical testing (FIT) generate substantial pressure on colonoscopy capacity in Europe. Thus, a relevant proportion of FIT-positive patients undergo colonoscopy after the recommended 30-day interval, which may be associated with an excess CRC risk. Methods In a cohort of 50–69-year-old patients undergoing biennial rounds of FIT (OC-Hemodia latex agglutination test; cutoff 20 µg hemoglobin/g feces) between 2004 and 2017, we assessed the outcome at colonoscopy (low/high risk adenoma/CRC/advanced stage CRC) among FIT-positive patients, according to different time intervals. The association of each outcome with waiting time, and demographic and clinical factors, was analyzed through multivariable analysis. Results 123 138/154 213 FIT-positive patients (79.8 %) underwent post-FIT colonoscopy. Time to colonoscopy was ≤ 30 days, 31–180 days, and ≥ 181 days in 50 406 (40.9 %), 71 724 (58.3 %), and 1008 (0.8 %) patients, respectively. At colonoscopy, CRC, high risk adenoma, and low risk adenoma were diagnosed in 4813 (3.9 %), 30 500 (24.8 %), and 22 986 (18.7 %) patients, respectively. An increased CRC prevalence at colonoscopy was observed for a time to colonoscopy of ≥ 270 days (odds ratio [OR] 1.75, 95 % confidence interval [CI] 1.15–2.67), whereas it was stable for waiting times of < 180 days. The proportion of advanced CRC also increased after 270 days (OR 2.79, 95 %CI 1.03–7.57). No increase for low or high risk adenomas according to time to colonoscopy was observed. Conclusion In a European FIT-based screening program, post-FIT colonoscopy after 9 months was associated with an increased risk of CRC and CRC progression.

Evaluation of cost-effectiveness of early KRAS testing in high-risk recurrence colorectal cancer patients in Italy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14113-e14113
Author(s):  
Carmine Pinto ◽  
Carlo Barone ◽  
Nicola Normanno ◽  
Francesco Cognetti ◽  
Alfredo Falcone ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
High Risk ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Sensitivity Analyses ◽  
Optimal Timing ◽  
Time Interval ◽  
Risk Of Recurrence ◽  
Risk Recurrence

e14113 Background: KRAS testing is relevant for the choice of the most appropriate first-line therapy for metastatic colorectal cancer (CRC) patients (pts). Early KRAS testing in surgically resected CRC pts at high risk of recurrence might result cost-effective when the results of KRAS test are not available in acceptable time following the diagnosis of metastatic disease. Methods: This study adopted the Delphi technique to reach a consensus to define high risk recurrence CRC and KRAS test optimal timing. We used validated decision analyses models employed by technology assessment agencies (NICE and SMC) for the assessment of KRAS wild-type CRC pts. Alternative therapeutic strategies include FOLFOX4, FOLFIRI, FOLFOX4 + cetuximab, FOLFIRI + cetuximab, FOLFOX4 + bevacizumab. We adapted the models to take into account early KRAS testing in high risk pts for which the test would not be available on time to drive appropriate treatment. The models have been populated with Italian specific cost data incorporating pts’ access schemes. Results: Issues related to KRAS testing were proposed to 108 Italian oncologists and pathologists through two subsequent questionnaires. The following parameters to define CRC pts at high risk of recurrence were identified: pT4, high grading, pN2, intestinal occlusion-perforation, isolated peritoneal carcinomatosis surgically removed and/or positive peritoneal washing and/or removed ovarian metastases. A time interval of more than 10-15 days for KRAS testing was defined as a limit for the therapeutic choices. Early KRAS testing in high risk CRC pts generates incremental cost effectiveness ratios between 6,000 and 13,000 Euro per quality adjusted life year (QALY) gained, depending on alternative treatment of choice. In extensive sensitivity analyses, ICER’s were always below 15,000 Euro per QALY gained, far within the 60,000 Euro/QALY gained threshold currently accepted in Italy. Conclusions: In metastatic CRC a time interval of more than 10-15 days for the response of KRAS testing limits the therapeutic choices. Early KRAS testing in high-risk CRC pts who would not have KRAS test in a reasonable time when they develop metastases is a cost effective strategy.

scholarly journals Cyclomodulins and Hemolysis in E. coli as Potential Low-Cost Non-Invasive Biomarkers for Colorectal Cancer Screening

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1165
Author(s):  
Kristýna Mezerová ◽  
Lubomír Starý ◽  
Pavel Zbořil ◽  
Ivo Klementa ◽  
Martin Stašek ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Low Cost ◽  
E Coli ◽  
Crc Screening ◽  
Non Invasive ◽  
Detection Approach ◽  
Gene Assay ◽  
Immunochemical Test ◽  
The Mean ◽  
And Performance

The frequent occurrence of E. coli positive for cyclomodulins such as colibactin (CLB), the cytotoxic necrotizing factor (CNF), and the cytolethal distending factor (CDT) in colorectal cancer (CRC) patients published so far provides the opportunity to use them as CRC screening markers. We examined the practicability and performance of a low-cost detection approach that relied on culture followed by simplified DNA extraction and PCR in E. coli isolates recovered from 130 CRC patients and 111 controls. Our results showed a statistically significant association between CRC and the presence of colibactin genes clbB and clbN, the cnf gene, and newly, the hemolytic phenotype of E. coli isolates. We also observed a significant increase in the mean number of morphologically distinct E. coli isolates per patient in the CRC cohort compared to controls, indicating that the cyclomodulin-producing E. coli strains may represent potentially preventable harmful newcomers in CRC patients. A colibactin gene assay showed the highest detection rate (45.4%), and males would benefit from the screening more than females. However, because of the high number of false positives, practical use of this marker must be explored. In our opinion, it may serve as an auxiliary marker to increase the specificity and/or sensitivity of the well-established fecal immunochemical test (FIT) in CRC screening.

scholarly journals Development of a new, simple and cost-effective diagnostic tool for genetic screening of hereditary colorectal cancer--the DNA microarray assay.

2013 ◽  
Vol 60 (2) ◽  
Author(s):  
Zoran Stojcev ◽  
Tomasz Banasiewicz ◽  
Michał Kaszuba ◽  
Adam Sikorski ◽  
Marek Szczepkowski ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
High Risk ◽  
Genetic Screening ◽  
Dna Microarrays ◽  
Risk Group ◽  
Cost Effective ◽  
High Risk Group ◽  
Hereditary Colorectal Cancer ◽  
Detection Of Mutations

Detection of mutations in families with a hereditary predisposition to colon cancer gives an opportunity to precisely define the high-risk group. 36 patients operated on for colon cancer, with familiar prevalence of this malignancy, were investigated using the DNA microarrays method with the potential detection of 170 mutations in MLH1, MSH2, MSH6, CHEK2, and NOD2 genes. In microarrays analysis of DNA in 9 patients (25% of the investigated group), 6 different mutations were found. The effectiveness of genetic screening using the microarray method is comparable to the effectiveness of other, much more expensive and time-consuming methods.

scholarly journals Performance of the Fecal Immunochemical Test in Patients With a Family History of Colorectal Cancer

2019 ◽  
Author(s):  
Sarvee Moosavi ◽  
Laura Gentile ◽  
Lovedeep Gondara ◽  
Colleen Mcgahan ◽  
Robert Alan Enns ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Logistic Regression ◽  
Family History ◽  
High Risk ◽  
Screening Program ◽  
Fecal Immunochemical Test ◽  
Study Cohort ◽  
Predictive Values ◽  
Two Samples ◽  
Immunochemical Test

Abstract Objective To assess the performance of a fecal immunochemical test (FIT) among participants of a population-based colorectal cancer (CRC) screening program with one or more first-degree relatives (FDR) with CRC. Methods Asymptomatic 50 to 74 years olds with a FDR diagnosed with CRC, enrolled in a colon screening program completed FIT (two samples, cut-off 20 µg Hemoglobin/gram feces) and underwent colonoscopy. FIT-interval CRCs were identified from the British Columbia cancer registry. Logistic regression analysis was used to identify variables associated with the detection of CRC and high-risk polyps (nonmalignant findings that required a 3-year surveillance colonoscopy) in those patients undergoing FIT and colonoscopy. Results Of the 1387 participants with a FDR with CRC, 1244 completed FIT with a positivity rate of 10.8%, 52 declined FIT but underwent colonoscopy and 90 declined screening. Seven CRCs were identified: six in patients with a positive FIT, one in a patient who only had colonoscopy. No CRCs were found in patients with a negative FIT. The positive and negative predictive values of FIT in the detection of CRC were 4.8% and 100%, respectively. On multivariate logistic regression, positive FIT, and not type of family history, was the only variable associated with detection of CRC or high-risk polyps. At 2-year follow-up, there was no FIT interval cancer detected in the study cohort. Conclusion FIT is more strongly associated with high-risk findings on colonoscopy than type of family history. FIT may be an alternative screening strategy to colonoscopy in individuals with a single FDR with CRC.

scholarly journals Cost-effectiveness analysis of alternative colorectal cancer screening strategies in high-risk individuals

2021 ◽  
Vol 14 ◽  
pp. 175628482110023
Author(s):  
Robert Benamouzig ◽  
Stéphanie Barré ◽  
Jean-Christophe Saurin ◽  
Henri Leleu ◽  
Alexandre Vimont ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
High Risk ◽  
Incremental Cost ◽  
Colorectal Cancer Screening ◽  
Cost Effective ◽  
Familial History ◽  
Screening Strategies ◽  
The Cost

Background and aims: Current guidelines recommend colonoscopy every 3–5 years for colorectal cancer (CRC) screening of individuals with a familial history of CRC. The objective of this study was to compare the cost effectiveness of screening alternatives in this population. Methods: Eight screening strategies were compared with no screening: fecal immunochemical test (FIT), Stool DNA and blood-based screening every 2 years, colonoscopy, computed tomography colonography, colon capsules, and sigmoidoscopy every 5 years, and colonoscopy at 45 years followed, if negative, by FIT every 2 years. Screening test and procedures performance were obtained from the literature. A microsimulation model reproducing the natural history of CRC was used to estimate the cost (€2018) and effectiveness [quality-adjusted life-years (QALYs)] of each strategy. A lifetime horizon was used. Costs and effectiveness were discounted at 3.5% annually. Results: Compared with no screening, colonoscopy and sigmoidoscopy at a 30% uptake were the most effective strategy (46.3 and 43.9 QALY/1000). FIT at a 30 µg/g threshold with 30% uptake was only half as effective (25.7 QALY). Colonoscopy was associated with a cost of €484,000 per 1000 individuals whereas sigmoidoscopy and FIT were associated with much lower costs (€123,610 and €66,860). Incremental cost-effectiveness rate for FIT and sigmoidoscopy were €2600/QALY ( versus no screening) and €3100/QALY ( versus FIT), respectively, whereas it was €150,000/QALY for colonoscopy ( versus sigmoidoscopy). With a lower threshold (10 µg/g) and a higher uptake of 45%, FIT was more effective and less costly than colonoscopy at a 30% uptake and was associated with an incremental cost–effectiveness ratio (ICER) of €4240/QALY versus no screening. Conclusion: At 30% uptake, current screening is the most effective screening strategy for high-risk individuals but is associated with a high ICER. Sigmoidoscopy and FIT at lower thresholds (10 µg/g) and a higher uptake should be given consideration as cost-effective alternatives. Plain Language Summary Cost-effectiveness analysis of colorectal cancer screening strategies in high-risk individuals Fecal occult blood testing with an immunochemical test (FIT) is generally considered as the most cost-effective alternative in colorectal cancer screening programs for average risk individuals without family history. Current screening guidelines for high-risk individuals with familial history recommend colonoscopy every 3–5 years. Colonoscopy every 3–5 years for individuals with familial history is the most effective strategy but is associated with a high incremental cost–effectiveness ratio. Compared with colonoscopy, if screening based on FIT is associated with a higher participation rate, it can achieve a similar effectiveness at a lower cost.

scholarly journals Optimal Postoperative Surveillance Strategies for Colorectal Cancer: A Retrospective Observational Study

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3502
Author(s):  
Min-Young Park ◽  
In-Ja Park ◽  
Hyo-Seon Ryu ◽  
Jay Jung ◽  
Min-Sung Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Lymphovascular Invasion ◽  
Radical Surgery ◽  
Recurrence Risk ◽  
Postoperative Surveillance ◽  
Free Survival ◽  
Low Intensity ◽  
Risk Patients ◽  
The Mean

This study aimed to assess whether surveillance intensity is associated with recurrence and survival in colorectal cancer (CRC) patients. Overall, 3794 patients with pathologic stage I–III CRC who underwent radical surgery between January 2012 and December 2014 were examined. Surveillance comprised abdominopelvic computed tomography (CT) every 6 months and chest CT annually for 5 years. Patients who underwent more than and less than an average of three imaging examinations annually were assigned to the high-intensity (HI) and low-intensity (LI) groups, respectively. Demographics were similar in both groups. T and N stages were higher and perineural and lymphovascular invasion were more frequent in the HI group (p < 0.001 each). The mean overall survival (OS) was similar for both groups; however, recurrence-free survival (RFS) was longer (p < 0.001) and post-recurrence survival (PRS) was shorter (p = 0.024) in the LI group. In the multivariate analysis, surveillance intensity was associated with RFS (p < 0.001) in contrast to PRS (p = 0.731). In patients with high recurrence risk predicted using the nomogram, OS was longer in the HI group (p < 0.001). A higher imaging frequency in patients at high risk of recurrence could be expected to lead to a slight increase in PRS but does not improve OS. Therefore, rather than increasing the number of CT scans in high-risk patients, other imaging modalities or innovative approaches, such as liquid biopsy, are required.

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