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

Eunate Arana-Arri; 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 Zapata; Leire 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

doi:10.1186/s12885-017-3555-3

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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Abstract

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 language	English
Article number	577
Pages (from-to)	1-13
Number of pages	13
Journal	BMC Cancer
Volume	17
Issue number	1
Early online date	29 Aug 2017
DOIs	https://doi.org/10.1186/s12885-017-3555-3
Publication status	Published - 29 Aug 2017

Keywords

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

ASJC Scopus subject areas

Oncology
Genetics
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12885-017-3555-3Licence: CC BY

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© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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Cite this

Arana-Arri, E., Idigoras, I., Uranga, B., Pérez, R., Irurzun, A., Gutiérrez-Ibarluzea, I., Fraser, C. G., Portillo, I., Luis Hurtado, J., de No, C., Enciso, C., Escalante, M., Atarés, B., Aguirre, J. J., Pereda, E., Marañón, E., Otazua, P., Fernández-Ávila, M. J., Egido, J. F., ... EUSKOLON Group (2017). Population-based colorectal cancer screening programmes using a faecal immunochemical test: Should faecal haemoglobin cut-offs differ by age and sex? BMC Cancer, 17(1), 1-13. Article 577. https://doi.org/10.1186/s12885-017-3555-3

@article{d7fdac2860e44c599e651cc5698b0d71,

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

abstract = "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.",

keywords = "Adenoma, Colorectal cancer, Faecal immunochemical test, Faecal occult blood test, Interval cancers, Screening",

author = "Eunate Arana-Arri and Isabel Idigoras and Bego{\~n}a Uranga and Raquel P{\'e}rez and Ana Irurzun and I{\~n}aki Guti{\'e}rrez-Ibarluzea and Fraser, {Callum G.} and Isabel Portillo and {Luis Hurtado}, Jos{\'e} and {de No}, Carmen and Carlos Enciso and Maite Escalante and Bego{\~n}a Atar{\'e}s and Aguirre, {Jos{\'e} Javier} and Esther Pereda and Edurne Mara{\~n}{\'o}n and Pedro Otazua and Fern{\'a}ndez-{\'A}vila, {Mar{\'i}a Jes{\'u}s} and Egido, {Jos{\'e} Francisco} and Eva Zapata and Leire Zubiaurre and Rodr{\'i}guez, {Juana Mari} and Sampedro, {Pedro Esteban} and Marisa Goyeneche and Arrinda, {Jos{\'e} Mar{\'i}a} and Jauregui, {Mari Luz} and Marta G{\'o}mez and Marta Saiz and Luis Bujanda and In{\'e}s Gil and Isabel Montalvo and Larzabal, {Jos{\'e} Miguel} and Maddi Garmendia and Fernando Izquierdo and Fern{\'a}ndez, {Francisco Javier} and Iago Rodr{\'i}guez and Alain Huerta and {de Miguel}, Eduardo and Inmaculada Barredo and Fidencio Bao and Anaiansi Hern{\'a}ndez and Isabel Rodriguez and Fern{\'a}ndez-Landa, {Mar{\'i}a Jos{\'e}} and Mar{\'i}a Imaz and Angel Calder{\'o}n and Francisco Polo and Nagore Arbide and Gaspar Lantar{\'o}n and Cristina Quesada and Itziar Marzana and {EUSKOLON Group}",

note = "no funding info",

year = "2017",

month = aug,

day = "29",

doi = "10.1186/s12885-017-3555-3",

language = "English",

volume = "17",

pages = "1--13",

journal = "BMC Cancer",

issn = "1471-2407",

publisher = "Springer Verlag",

number = "1",

}

Arana-Arri, E, Idigoras, I, Uranga, B, Pérez, R, Irurzun, A, Gutiérrez-Ibarluzea, I, Fraser, CG, Portillo, I, Luis Hurtado, J, de No, C, Enciso, C, Escalante, M, Atarés, B, Aguirre, JJ, Pereda, E, Marañón, E, Otazua, P, Fernández-Ávila, MJ, Egido, JF, Zapata, E, Zubiaurre, L, Rodríguez, JM, Sampedro, PE, Goyeneche, M, Arrinda, JM, Jauregui, ML, Gómez, M, Saiz, M, Bujanda, L, Gil, I, Montalvo, I, Larzabal, JM, Garmendia, M, Izquierdo, F, Fernández, FJ, Rodríguez, I, Huerta, A, de Miguel, E, Barredo, I, Bao, F, Hernández, A, Rodriguez, I, Fernández-Landa, MJ, Imaz, M, Calderón, A, Polo, F, Arbide, N, Lantarón, G, Quesada, C, Marzana, I & EUSKOLON Group 2017, 'Population-based colorectal cancer screening programmes using a faecal immunochemical test: Should faecal haemoglobin cut-offs differ by age and sex?', BMC Cancer, vol. 17, no. 1, 577, pp. 1-13. https://doi.org/10.1186/s12885-017-3555-3

TY - JOUR

T1 - Population-based colorectal cancer screening programmes using a faecal immunochemical test

T2 - Should faecal haemoglobin cut-offs differ by age and sex?

AU - Arana-Arri, Eunate

AU - Idigoras, Isabel

AU - Uranga, Begoña

AU - Pérez, Raquel

AU - Irurzun, Ana

AU - Gutiérrez-Ibarluzea, Iñaki

AU - Fraser, Callum G.

AU - Portillo, Isabel

AU - Luis Hurtado, José

AU - de No, Carmen

AU - Enciso, Carlos

AU - Escalante, Maite

AU - Atarés, Begoña

AU - Aguirre, José Javier

AU - Pereda, Esther

AU - Marañón, Edurne

AU - Otazua, Pedro

AU - Fernández-Ávila, María Jesús

AU - Egido, José Francisco

AU - Zapata, Eva

AU - Zubiaurre, Leire

AU - Rodríguez, Juana Mari

AU - Sampedro, Pedro Esteban

AU - Goyeneche, Marisa

AU - Arrinda, José María

AU - Jauregui, Mari Luz

AU - Gómez, Marta

AU - Saiz, Marta

AU - Bujanda, Luis

AU - Gil, Inés

AU - Montalvo, Isabel

AU - Larzabal, José Miguel

AU - Garmendia, Maddi

AU - Izquierdo, Fernando

AU - Fernández, Francisco Javier

AU - Rodríguez, Iago

AU - Huerta, Alain

AU - de Miguel, Eduardo

AU - Barredo, Inmaculada

AU - Bao, Fidencio

AU - Hernández, Anaiansi

AU - Rodriguez, Isabel

AU - Fernández-Landa, María José

AU - Imaz, María

AU - Calderón, Angel

AU - Polo, Francisco

AU - Arbide, Nagore

AU - Lantarón, Gaspar

AU - Quesada, Cristina

AU - Marzana, Itziar

AU - EUSKOLON Group

N1 - no funding info

PY - 2017/8/29

Y1 - 2017/8/29

N2 - 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.

AB - 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.

KW - Adenoma

KW - Colorectal cancer

KW - Faecal immunochemical test

KW - Faecal occult blood test

KW - Interval cancers

KW - Screening

UR - http://www.scopus.com/inward/record.url?scp=85028500818&partnerID=8YFLogxK

U2 - 10.1186/s12885-017-3555-3

DO - 10.1186/s12885-017-3555-3

M3 - Article

C2 - 28851318

AN - SCOPUS:85028500818

SN - 1471-2407

VL - 17

SP - 1

EP - 13

JO - BMC Cancer

JF - BMC Cancer

IS - 1

M1 - 577

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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