Population-based colorectal cancer screening programmes using a faecal immunochemical test: Should faecal haemoglobin cut-offs differ by age and sex?

Eunate Arana-Arri (Lead / Corresponding author), Isabel Idigoras, Begoña Uranga, Raquel Pérez, Ana Irurzun, Iñaki Gutiérrez-Ibarluzea, Callum G. Fraser, Isabel Portillo, José Luis Hurtado, Carmen de No, Carlos Enciso, Maite Escalante, Begoña Atarés, José Javier Aguirre, Esther Pereda, Edurne Marañón, Pedro Otazua, María Jesús Fernández-Ávila, José Francisco Egido, Eva ZapataLeire Zubiaurre, Juana Mari Rodríguez, Pedro Esteban Sampedro, Marisa Goyeneche, José María Arrinda, Mari Luz Jauregui, Marta Gómez, Marta Saiz, Luis Bujanda, Inés Gil, Isabel Montalvo, José Miguel Larzabal, Maddi Garmendia, Fernando Izquierdo, Francisco Javier Fernández, Iago Rodríguez, Alain Huerta, Eduardo de Miguel, Inmaculada Barredo, Fidencio Bao, Anaiansi Hernández, Isabel Rodriguez, María José Fernández-Landa, María Imaz, Angel Calderón, Francisco Polo, Nagore Arbide, Gaspar Lantarón, Cristina Quesada, Itziar Marzana, EUSKOLON Group

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    Background: The Basque Colorectal Cancer Screening Programme has both high participation rate and high compliance rate of colonoscopy after a positive faecal occult blood test (FIT). Although, colorectal cancer (CRC) screening with biannual (FIT) has shown to reduce CRC mortality, the ultimate effectiveness of the screening programmes depends on the accuracy of FIT and post-FIT colonoscopy, and thus, harms related to false results might not be underestimated. Current CRC screening programmes use a single faecal haemoglobin concentration (f-Hb) cut-off for colonoscopy referral for both sexes and all ages. We aimed to determine optimum f-Hb cut-offs by sex and age without compromising neoplasia detection and interval cancer proportion.

    Methods: Prospective cohort study using a single-sample faecal immunochemical test (FIT) on 444,582 invited average-risk subjects aged 50-69 years. A result was considered positive at ≥20 μg Hb/g faeces. Outcome measures were analysed by sex and age for a wide range of f-Hb cut-offs.

    Results: We analysed 17,387 positive participants in the programme who underwent colonoscopy. Participation rate was 66.5%. Men had a positivity rate for f-Hb of 8.3% and women 4.8% (p < 0.0001). The detection rate for advanced neoplasia (cancer plus advanced adenoma) was 44.0% for men and 15.9% for women (p < 0.0001). The number of colonoscopies required decreased in both sexes and all age groups through increasing the f-Hb cut-off. However, the loss in CRC detection increased by up to 28.1% in men and 22.9% in women. CRC missed were generally at early stages (Stage I-II: from 70.2% in men to 66.3% in women). Conclusions: This study provides detailed outcomes in men and women of different ages at a range of f-Hb cut-offs. We found differences in positivity rates, neoplasia detection rate, number needed to screen, and interval cancers in men and women and in younger and older groups. However, there are factors other than sex and age to consider when consideration is given to setting the f-Hb cut-off.

    Original languageEnglish
    Article number577
    Pages (from-to)1-13
    Number of pages13
    JournalBMC Cancer
    Issue number1
    Early online date29 Aug 2017
    Publication statusPublished - 29 Aug 2017


    • Adenoma
    • Colorectal cancer
    • Faecal immunochemical test
    • Faecal occult blood test
    • Interval cancers
    • Screening

    ASJC Scopus subject areas

    • Oncology
    • Genetics
    • Cancer Research


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