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High sensitivity of five colorectal screening programmes with faecal immunochemical test in the Veneto Region, Italy
  1. Manuel Zorzi1,
  2. Chiara Fedato1,
  3. Grazia Grazzini2,
  4. Fiorella Carmen Stocco1,
  5. Flavio Banovich3,
  6. Antonio Bortoli4,
  7. Luigi Cazzola5,
  8. Adriana Montaguti6,
  9. Tina Moretto7,
  10. Marco Zappa2,
  11. Marcello Vettorazzi1
  1. 1Veneto Tumour Registry, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
  2. 2Screening Department, Cancer Prevention and Research Institute (ISPO) Florence, Italy
  3. 3Department of Prevention, Local Health Unit n° 4 Alto Vicentino, Italy
  4. 4Department of Prevention, Local Health Unit n° 22 Bussolengo, Italy
  5. 5Department of Prevention, Local Health Unit n° 2 Feltre, Italy
  6. 6Screening Unit, Local Health Unit n° 13 Dolo Mirano, Italy
  7. 7Department of Prevention, Local Health Unit n° 7 Pieve di Soligo, Italy
  1. Correspondence to Dr Manuel Zorzi, Veneto Tumour Registry, Istituto Oncologico Veneto IRCCS, P.ggio Gaudenzio, 1, 35132 Padua, Italy; manuel.zorzi{at}ioveneto.it

Abstract

Objective Although guaiac-based faecal occult blood test screening has been shown to be effective in reducing colorectal cancer (CRC) mortality, it has been criticised mostly for its low sensitivity. Italian CRC screening programmes are based on immunochemical tests (iFOBT). We collected and analysed the interval cancers (ICs) found by five screening programmes to estimate their sensitivity.

Methods ICs were identified in subjects who had a negative result in a screening examination from 2002 to 2007 (N=267 789); data were linked with 2002–2008 hospital discharge records. Analysis was based on the follow up of 468 306 person-years. The proportional incidence-based sensitivity was estimated overall and by sex, age class, time since last negative iFOBT result, anatomical site, and history of screening (first or subsequent test).

Results Overall, 126 ICs were identified, compared to 572 expected cancers. The proportional incidences were 15.3% and 31.0% in the first and the second interval-years, respectively, with an overall episode sensitivity of 78.0% (95% CI: 73.8 to 81.6). Sensitivity was higher for males than females (80.1% vs 74.8%); no differences were observed by age, anatomical site or between programmes. The test sensitivity of iFOBT was 82.1% (95% CI 78.1% to 85.3%).

Conclusions iFOBT-based screening programmes showed a high performance in terms of sensitivity as estimated through the IC rates. The screening schedule utilised in our programmes (single iFOBT, positivity threshold of 100 ng Hb/ml of sample solution, inter-screening interval of 2 years) shows low rates of missed cancers that are diagnosed during the interval. HDR are a convenient and reliable source of data for IC studies.

  • Colorectal cancer
  • screening
  • fecal occult blood tests
  • sensitivity
  • proportional incidence method
  • colorectal cancer screening

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Footnotes

  • Funding The evaluation and analysis was done at the Veneto Tumour Registry, IOV IRCCS.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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