Interval cancers using a quantitative faecal immunochemical test (FIT) for haemoglobin when colonoscopy capacity is limited

Jayne Digby (Lead / Corresponding author), Callum G. Fraser, Francis A. Carey, Jaroslaw Lang, Greig Stanners, Robert J. C. Steele

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    Abstract

    Objectives: Quantitative faecal immunochemical tests (FIT) for faecal haemoglobin (f-Hb) in colorectal cancer (CRC) screening pose challenges when colonoscopy is limited. For low positivity rates, high f-Hb concentration cut-offs are required, but little is known about interval cancer (IC) proportions using FIT. We assessed IC proportions using an 80 µg Hb/g cut-off.

    Methods: In two NHS Boards in the Scottish Bowel Screening Programme, f-Hb was estimated for 30,893 participants aged 50-75, of whom 753 participants with f-Hb ≥ 80 µg Hb/g were referred for colonoscopy. ICs, defined as CRC within two years of a negative result, were identified from the Scottish Cancer Registry.

    Results: There were 31 ICs and 30 screen-detected (SD) CRCs, an IC proportion of 50.8% (48.4% for men, 53.3% for women). CRC site distribution was similar between ICs and SD, but ICs were later stage (46.7% and 33.3%, Dukes' stages C and D, respectively). Of 31 ICs, 23 had f-Hb < 10 µg Hb/g, including six with undetectable f-Hb. A f-Hb cut-off of 10 µg Hb/g would have raised the positivity rate from 2.4% to 9.4%, increased colonoscopy requirement from 753 to 2147, and reduced the IC proportion to 38.3%.

    Conclusions: The IC proportion was similar to that seen with guaiac-based FOBT. The later stage distribution of ICs highlights the benefits of lower f-Hb cut-offs, but with 19.4% of ICs having undetectable f-Hb, some cancers would have been missed, even with drastic reduction in the f-Hb cut-off.

    Original languageEnglish
    Pages (from-to)130-134
    Number of pages5
    JournalJournal of Medical Screening
    Volume23
    Issue number3
    Early online date19 Nov 2015
    DOIs
    Publication statusPublished - 8 Aug 2016

    Keywords

    • Colorectal cancer
    • faecal haemoglobin
    • faecal immunochemical test
    • faecal occult blood test
    • interval cancers

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