scholarly journals The Addition of Other Fecal Biomarkers Does Not Improve the Diagnostic Accuracy of Immunochemical Fecal Occult Blood Test Alone in a Colorrectal Cancer Screening Cohort

2021 ◽  
Vol 8 ◽  
Author(s):  
Gonzalo Hijos-Mallada ◽  
Alberto Lué ◽  
Raul Velamazan ◽  
Nuria Saura ◽  
Carlos Abril ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Advanced Adenoma ◽  
Fecal Occult Blood ◽  
Crc Screening ◽  
Advanced Neoplasia ◽  
Fecal Occult ◽  
Fecal Biomarkers

Background: Screening with fecal occult blood test reduces colorectal cancer (CRC) incidence and mortality, and is currently implemented in most countries. However, around 40% of screening colonoscopies are normal. Thus, strategies to avoid these colonoscopies are highly necessary. Adding other fecal biomarkers, such as fecal calprotectin (FC), lactoferrin, and transferrin may be useful, but evidence is scarce.Aims: To evaluate the diagnostic accuracy of fecal occult blood immunochemical test (FIT), FC, and a one-step combo card test for the simultaneous semi-qualitative detection of human hemoglobin (hHb), transferrin (hTf), calprotectin (hCp) and lactoferrin (hLf) in a CRC screening program population.Methods: Single-center, prospective observational study, enrolling patients included in a CRC screening program, referred for a colonoscopy due to a positive FIT test. Participants collected a stool sample prior to bowel preparation, and FIT, FC and the combo semi-qualitative tests were performed on the sample. Sensitivity, specificity, positive and negative predictive values and area under receiver operator curve (AUC) for diagnosis of advanced neoplasia, advanced adenoma and CRC were estimated for each biomarker and their combinations. The primary endpoint of the study was to assess whether these biomarkers could improve the diagnostic accuracy of FIT alone.Results: 336 consecutive patients (64% males) were recruited. Advanced neoplasia was found in 129/336 (38.4%) patients, and of these, 22/336 (6.5%) were diagnosed of CRC. 153/336 (45.5%) colonoscopies were completely normal. The AUC for the diagnosis of advanced neoplasia were 0.725 (95%CI 0.665–0.784) for FIT, 0.477 (95%CI 0.413–0.541) for FC and 0.732 (95%CI 0.674–0.791) for the combination of both (FIT + FC) quantitative tests. The AUCs for the combo test were 0.70 (95%CI 0.641–0.760) for hHb, 0.625 (95%CI 0.562–0.698) for hTf, 0.532 (95%CI 0.469–0.595) for hCp, 0.531 (95%CI 0.466–0.595 ) for hLf and 0.681 (95%CI 0.620–0.741) for the combination of the four biomarkers.Conclusion: In average-risk population, FIT appears to be the best fecal marker for the diagnosis of CRC and advanced adenoma. None of the other biomarkers explored or their combinations provided a better diagnostic accuracy. Only hTF showed an acceptable diagnostic accuracy. FC and hLF were not useful in this setting.

scholarly journals Gastroscopy Following a Positive Fecal Occult Blood Test and Negative Colonoscopy: Systematic Review and Guideline

2010 ◽  
Vol 24 (2) ◽  
pp. 113-120 ◽  
Author(s):  
Johane Allard ◽  
Roxanne Cosby ◽  
M Elisabeth Del Giudice ◽  
E Jan Irvine ◽  
David Morgan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Occult Blood Test ◽  
Crc Screening ◽  
Fecal Occult

BACKGROUND: A sizeable number of individuals who participate in population-based colorectal cancer (CRC) screening programs and have a positive fecal occult blood test (FOBT) do not have an identifiable lesion found at colonoscopy to account for their positive FOBT screen.OBJECTIVE: To evaluate the evidence and provide recommendations regarding the use of routine esophagogastroduodenoscopy (EGD) to detect upper gastrointestinal (UGI) cancers in patients participating in a population-based CRC screening program who are FOBT positive and colonoscopy negative.METHODS: A systematic review was used to develop the evidentiary base and to inform the evidence-based recommendations provided.RESULTS: Nine studies identified a group of patients who were FOBT positive and colonoscopy negative. Three studies found no cases of UGI cancer. Four studies reported cases of UGI cancer; three found UGI cancer in 1% or less of the population studied, and one study found one case of UGI cancer that represented 7% of their small subgroup of FOBT-positive/colonoscopy-negative patients. Two studies did not provide outcome information that could be specifically related to the FOBT-positive/colonoscopy-negative subgroup.CONCLUSION: The current body of evidence is insufficient to recommend for or against routine EGD as a means of detecting gastric or esophageal cancers for patients who are FOBT positive/colonoscopy negative, in a population-based CRC screening program. The decision to perform EGD should be individualized and based on clinical judgement.

scholarly journals Validity of Fecal Occult Blood Test in the National Cancer Screening Program, Korea

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e79292 ◽  
Author(s):  
Aesun Shin ◽  
Kui Son Choi ◽  
Jae Kwan Jun ◽  
Dai Keun Noh ◽  
Mina Suh ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Occult Blood Test ◽  
Fecal Occult ◽  
Cancer Screening Program

Colon capsule versus computed tomography colonography for colorectal cancer screening in patients with positive fecal occult blood test who refuse colonoscopy: a randomized trial

Endoscopy ◽  
2018 ◽  
Vol 50 (08) ◽  
pp. 761-769 ◽  
Author(s):  
Mathieu Pioche ◽  
Christell Ganne ◽  
Rodica Gincul ◽  
Antoine De Leusse ◽  
Julien Marsot ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Occult Blood Test ◽  
Computed Tomography Colonography ◽  
Invitation Letter ◽  
Fecal Occult

Abstract Objective Some patients (10 % – 32 %) with a positive guaiac fecal occult blood test (gFOBT) do not undergo the recommended colonoscopy. The aim of this study was to compare video capsule endoscopy (VCE) and computed tomography colonography (CTC) in terms of participation rate and detection outcomes when offered to patients with a positive gFOBT who did not undergo the recommended colonoscopy. Methods An invitation letter offering CTC or VCE was sent to selected patients after randomization. Acceptance of the proposed (or alternative) procedure and procedure results were recorded. Sample size was evaluated according to the hypothesis of a 13 % increase of participation with VCE. Results A total of 756 patients were targeted. Following the invitation letter, 5.0 % (19/378) of patients underwent the proposed VCE and 7.4 % (28/378) underwent CTC, (P = 0.18). Following the letter, 9.8 % (37/378) of patients in the VCE group underwent a diagnostic procedure (19 VCE, 1 CTC, 17 colonoscopy) vs. 10.8 % in the CTC group (41/378: 28 CTC, 13 colonoscopy; P = 0.55). There were more potentially neoplastic lesions diagnosed in the VCE group than in the CTC group (12/20 [60.0 %] vs. 8/28 [28.6 %]; P = 0.04). Thus, 15/20 noninvasive procedures in the VCE group (19 VCE, 1 CTC; 75.0 %) vs. 10/28 in the CTC group (35.7 %; P = 0.01) resulted in a recommendation of further colonoscopy, but only 10/25 patients actually underwent this proposed colonoscopy. Conclusion Patients with a positive gFOBT result who do not undergo the recommended colonoscopy are difficult to recruit to the screening program and simply proposing an additional, less-invasive procedure, such as VCE or CTC, is not an effective strategy.

scholarly journals The impact of Endocuff-assisted colonoscopy on adenoma detection in an organized screening program

2018 ◽  
Vol 06 (04) ◽  
pp. E437-E442 ◽  
Author(s):  
Lucas Cavallaro ◽  
Cesare Hassan ◽  
Pierenrico Lecis ◽  
Ermenegildo Galliani ◽  
Elisabetta Dal Pont ◽  
...  
Keyword(s):  
Detection Rate ◽  
Screening Program ◽  
Occult Blood ◽  
Adenoma Detection Rate ◽  
Advanced Adenoma ◽  
Fecal Occult Blood ◽  
Crc Screening ◽  
Adenoma Detection ◽  
Number Of Patients ◽  
The Impact

Abstract Background and study aims Colorectal cancer (CRC) screening with biennial fecal occult blood test has been shown to reduce CRC mortality. For the effectiveness of the CRC screening program is crucial that a high-quality colonoscopy with a high adenoma detection rate (ADR) be performed. To improve ADR, various endoscopic devices have been developed. Endocuff, an endoscopic cap with finger-like projections, has been shown to improve ADR. The aim of this study was to compare in an organized CRC screening program ADR, advanced adenoma detection rate (AADR) and mean number of adenomas per patient (MAP) using standard colonoscopy (SC) and Endocuff-assisted colonoscopy (EAC). Patients and methods We compared performance of SC (in 2014) and EAC (in 2015) in consecutive participants in an organized CRC screening program. Results SC and EAC were performed in 546 (284 males) and 519 (293 males) subjects, respectively (mean age 60 years). Cecal intubation rate was 97.4 % for SC and 97.1 % for EAC and not significantly different (P = 0.7). ADR was 47 % for SC and 52 % for EAC, P = 0.1. MAP in SC and EAC were 0.87 (range: 0 – 7) and 1.11 (range: 0 – 13) respectively, P = 0.02. AADR rate was 25 % and 23 % for SC and EAC, respectively, P = 0.5. Conclusion Endocuff-assisted colonoscopy does not improve the number of patients with at least one adenoma but it may increase the number of detected adenomas per procedure.

Colorectal cancer screening: Why do some people never participate? Results from the EDIFICE surveys.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 565-565
Author(s):  
Jerome Viguier ◽  
François Eisinger ◽  
Chantal Touboul ◽  
Christine Lhomel ◽  
Jean F. Morere
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Blood Test ◽  
Fecal Occult Blood Test ◽  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Age Group ◽  
Occult Blood Test ◽  
Fecal Occult

565 Background: The aim of EDIFICE surveys is to improve insight into the behavior of the French population with regard to cancer prevention and participation in screening programs. Via the colorectal cancer (CRC) screening program, all average-risk individuals in the 50-74-yr age group are invited every 2 years to do a guaiac-based or immunochemical fecal occult blood test. This analysis focuses on lay-population reasons for not undergoing the test. Methods: The 5th nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1299 individuals with no history of cancer (age, 50-74 yrs) was interviewed between 22 November and 7 December 2016. Those who had never undertaken a screening test were asked for their reasons. Results: In total, 64% reported having undergone a screening test (colonoscopy, fecal occult blood test) at least once in their lifetime (coverage). There was a non-significant (NS) increase in coverage rates over the period 2014-2016. In 2016, the most frequently (36%) cited reason for not being screened was “individual negligence/not a priority”. This figure was significantly higher than in 2014 (24%, P < 0.05). Between one in four and one in five respondents answered “no risk factor” in both 2014 and 2016. Approximately one in ten respondents gave “pointlessness” as their reason for not being screened (12% in 2016 vs 8% in 2014, NS) while “fear of the examination or fear of the results”, “reasons related to the physician (he never suggested it” [3.8% in 2016] or “he recommended against screening” [2.5% in 2016]), or “refusal to participate”, all dropped significantly between 2014 and 2016. Conclusions: The issue of “individual negligence” requires further analysis so as to clearly define the categories of individuals who remain unreceptive to screening and identify how best to involve them. The significant mention of “no risk factors” reveals ignorance of the fact that the colorectal cancer screening program actually targets all individuals in a given age group, regardless of individual risk factors. The decrease in reasons involving “fear" or related to the physician may be a result of awareness campaigns and GP mobilization.

scholarly journals Colorectal Cancer Screening in Average Risk Populations: Evidence Summary

2016 ◽  
Vol 2016 ◽  
pp. 1-18 ◽  
Author(s):  
Jill Tinmouth ◽  
Emily T. Vella ◽  
Nancy N. Baxter ◽  
Catherine Dubé ◽  
Michael Gould ◽  
...  
Keyword(s):  
Screening Program ◽  
Occult Blood ◽  
Screening Tests ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Crc Screening ◽  
Fecal Occult ◽  
Evidence Summary ◽  
Screening Intervals ◽  
Meta Analyses

Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC.Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions.Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality.Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.

scholarly journals Evaluation of Effectiveness, Benefit Harm and Cost Effectiveness of Colonoscopy and Occult Blood Tests for an Organized Population-based Colorectal Cancer Screening in Austria

2019 ◽  
Author(s):  
Beate Jahn ◽  
Gaby Sroczyn ◽  
Marvin Bundo ◽  
Nikolai Mühlberger ◽  
Sibylle Puntscher ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Blood Test ◽  
Occult Blood ◽  
Population Based ◽  
Positive Test ◽  
Fecal Occult Blood ◽  
Test Results ◽  
Crc Screening ◽  
Fecal Occult ◽  
Psychological Harm

Abstract Background: Clear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in Austria. Methods: A decision-analytic Markov cohort model for colorectal adenoma and cancer with a lifelong time horizon was developed, calibrated to the Austrian epidemiological setting and validated. We compared four strategies: 1) No Screening, 2) FIT: annual immunochemical fecal occult blood test age 40-75 years, 3) gFOBT: annual guaiac-based fecal occult blood test age 40-75 years, and 4) COL: 10-yearly colonoscopy age 50-70 years. Predicted outcomes included: benefits as life-years gained [LYG], CRC-related deaths avoided and CRC cases avoided; harms as additional complications due to colonoscopy (physical harm) and positive test results (psychological harm); and lifetime costs. Tradeoffs were expressed as incremental harm-benefit ratios (IHBR, incremental positive test results per LYG) and incremental cost-effectiveness ratios [ICER]. The perspective of the Austrian public health care system was adopted. Comprehensive sensitivity analyses were performed to assess uncertainty. Results: The most effective strategies were FIT and COL. The IHBR to move from COL to FIT has an expected incremental unintended psychological harm of 16 additional positive test results to gain one life-year. COL was cost saving compared to No Screening. gFOBT was dominated by FIT. Moving from COL to FIT has an ICER of 15000 EUR/LYG. Conclusions: Organized CRC-screening with annual FIT or 10-yearly colonoscopy is most effective. The choice between these two options depends on the individual preferences and benefit-harm tradeoffs of screening candidates.

scholarly journals Cause of Death, Mortality and Occult Blood in Colorectal Cancer Screening

Cancers ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 246
Author(s):  
Lasse Kaalby ◽  
Issam Al-Najami ◽  
Ulrik Deding ◽  
Gabriele Berg-Beckhoff ◽  
Robert J. C. Steele ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cause Of Death ◽  
Blood Test ◽  
Occult Blood ◽  
Fecal Occult Blood ◽  
Time Varying ◽  
Hemoglobin F ◽  
Crc Screening ◽  
Fecal Occult ◽  
Hazard Ratios

Fecal hemoglobin (f-Hb) detected by the guaiac fecal occult blood test (gFOBT) may be associated with mortality and cause of death in colorectal cancer (CRC) screening participants. We investigated this association in a randomly selected population of 20,694 participants followed for 33 years. We followed participants from the start of the Hemoccult-II CRC trial in 1985–1986 until December 2018. Data on mortality, cause of death and covariates were retrieved using Danish national registers. We conducted multivariable Cox regressions with time-varying exposure, reporting results as crude and adjusted hazard ratios (aHRs). We identified 1766 patients with at least one positive gFOBT, 946 of whom died in the study period. Most gFOBT-positive participants (93.23%) died of diseases unrelated to CRC and showed higher non-CRC mortality than gFOBT-negative participants (aHR: 1.20, 95% CI 1.10–1.30). Positive gFOBT participants displayed a modest increase in all-cause (aHR: 1.28, 95% CI: 1.18–1.38), CRC (aHR: 4.07, 95% CI: 3.00–5.56), cardiovascular (aHR: 1.22, 95% CI: 1.07–1.39) and endocrine and hematological mortality (aHR: 1.58, 95% CI: 1.19–2.10). In conclusion, we observed an association between positive gFOBT, cause of death and mortality. The presence of f-Hb in the gFOBT might indicate the presence of systemic diseases.

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