False-negative rate cannot be reduced by lowering the haemoglobin concentration cut-off in colorectal cancer screening using faecal immunochemical test

Objective There is evidence that colorectal cancer screening using faecal haemoglobin is less effective in women than men. The faecal haemoglobin concentrations were therefore examined in women and men with screen-detected colorectal cancer. Setting Scottish Bowel Screening Programme, following the introduction of a faecal immunochemical test from November 2017, to March 2020. Methods Data were collated on faecal haemoglobin concentrations, pathological stage and anatomical site of the main lesion in participants who had colorectal cancer detected. The data in women and men were compared. Results For the faecal haemoglobin concentrations studied (>80 µg Hb/g faeces), the distributions indicated lower concentrations in women. Marked differences were found between women and men diagnosed with colorectal cancer. The median faecal haemoglobin concentration for women ( n = 720) was 408 µg Hb/g faeces compared to 473 µg Hb/g faeces for men ( n = 959) ( p = 0.004) and 50.6% of the results were >400 µg Hb/g faeces in women; in men, this was 57.8%. The difference in faecal haemoglobin concentrations in women and men became less statistically significant as stage advanced from stages I–IV. For right-sided, left-sided and rectal colorectal cancer, a similar gender difference persisted in all sites. Differences in faecal haemoglobin between the genders were significant for left-sided cancers and stage I and approached significance for rectal cancers and stage II, but all sites and stages showed lower median faecal haemoglobin concentrations for women. Conclusions To minimise gender inequalities, faecal immunochemical test-based colorectal cancer screening programmes should evaluate a strategy of using different faecal haemoglobin concentration thresholds in women and men.

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RISK FACTORS FOR FALSE-POSITIVE AND FALSE-NEGATIVE FECAL IMMUNOCHEMICAL TEST RESULTS IN COLORECTAL CANCER SCREENING: SYSTEMATIC REVIEW AND META-ANALYSIS

10.1055/s-0038-1637308 ◽

2018 ◽

Author(s):

CM de Klerk ◽

LM Vendrig ◽

PM Bossuyt ◽

E Dekker

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Systematic Review ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

False Positive ◽

Meta Analysis ◽

False Negative ◽

Test Results ◽

Immunochemical Test

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Individualized Faecal Immunochemical Test Cut-off based on Age and Sex in Colorectal Cancer Screening

Preventive Medicine Reports ◽

10.1016/j.pmedr.2021.101447 ◽

2021 ◽

pp. 101447

Author(s):

Tim L. Kortlever ◽

Manon van der Vlugt ◽

Evelien Dekker ◽

Patrick M.M. Bossuyt

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Faecal Immunochemical Test ◽

Immunochemical Test ◽

Age And Sex

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Interval cancers after negative immunochemical test compared to screen and non-responders’ detected cancers in Slovenian colorectal cancer screening programme

Radiology and Oncology ◽

10.2478/raon-2018-0025 ◽

2018 ◽

Vol 52 (4) ◽

pp. 413-421 ◽

Cited By ~ 2

Author(s):

Dominika Novak Mlakar ◽

Tatjana Kofol Bric ◽

Ana Lucija Škrjanec ◽

Mateja Krajc

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Screening Test ◽

Screening Programme ◽

Interval Cancers ◽

Faecal Immunochemical Test ◽

Test Sensitivity ◽

Cancer Screening Programme ◽

Immunochemical Test

Abstract Background We assessed the incidence and characteristics of interval cancers after faecal immunochemical occult blood test and calculated the test sensitivity in Slovenian colorectal cancer screening programme. Patients and methods The analysis included the population aged between 50 to 69 years, which was invited for screening between April 2011 and December 2012. The persons were followed-up until the next foreseen invitation, in average for 2 years. The data on interval cancers and cancers in non-responders were obtained from cancer registry. Gender, age, years of schooling, the cancer site and stage were compared among three observed groups. We used the proportional incidence method to calculate the screening test sensitivity. Results Among 502,488 persons invited for screening, 493 cancers were detected after positive screening test, 79 interval cancers after negative faecal immunochemical test and 395 in non-responders. The proportion of interval cancers was 13.8%. Among the three observed groups cancers were more frequent in men (p = 0.009) and in persons aged 60+ years (p < 0.001). Comparing screen detected and cancers in non-responders with interval cancers more interval cancers were detected in persons with 10 years of schooling or more (p = 0.029 and p = 0.001), in stage III (p = 0.027) and IV (p < 0.001), and in right hemicolon (p < 0.001). Interval cancers were more frequently in stage I than non-responders cancers (p = 0.004). Test sensitivity of faecal immunochemical test was 88.45%. Conclusions Interval cancers in Slovenian screening programme were detected in expected proportions as in similar programmes. Test sensitivity was among the highest when compared to similar programmes and was accomplished using test kit for two stool samples.

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