Random comparison of repeated faecal immunochemical testing at different intervals for population-based colorectal cancer screening
- Aafke H C van Roon1,
- S Luuk Goede2,
- Marjolein van Ballegooijen2,
- Anneke J van Vuuren1,
- Caspar W N Looman2,
- Katharina Biermann3,
- Jacqueline C I Y Reijerink4,
- Hans 't Mannetje4,
- Alexandra C M van der Togt5,
- J Dik F Habbema2,
- Monique E van Leerdam1,
- Ernst J Kuipers1,6
- 1Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- 2Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
- 3Department of Pathology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- 4Nationwide Screening Organization for the South-western Netherlands, Rotterdam, The Netherlands
- 5Comprehensive Cancer Centre, Rotterdam, The Netherlands
- 6Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Correspondence to Aafke H C van Roon, Erasmus University Medical Centre, Department of Gastroenterology and Hepatology (room Hs-306), 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands;
Contributors EJK, JDFH, MvB and MEvL conceived the idea for the study. EJK, JDFH, MvB and MEvL designed the protocol. EJK and JDFH supervised the execution of the study. JCIYR and HtM were responsible for the retrieval of the target population from the municipal registries and all mailings. HtM performed the retrieval of the study samples and randomisation in collaboration with Tenalea, Amsterdam. AJvV was responsible for the analyses of all FIT samples. KB evaluated all pathology biopsies of the colonoscopies at the Erasmus University Medical Centre. JCIYR, HtM, MEvL and AHCvR were responsible for the database design. AHCvR was responsible for data entry and drafted the report. AHCvR and CWNL performed the statistical analyses. All co-authors read and approved the final version of the paper.
- Revised 7 January 2012
- Accepted 9 January 2012
- Published Online First 2 March 2012
Objective Colorectal cancer screening by means of faecal immunochemical tests (FITs) requires successive screening rounds for an optimal preventive effect. However, data on the influence of the length of the screening interval on participation and diagnostic yield are lacking. Repeated FIT screening was therefore performed in a population-based trial comparing various repeat intervals.
Design 7501 Dutch individuals aged 50–74 years were randomly selected and invited for two 1-sample FIT screening rounds (haemoglobin (Hb) concentration ≥50 ng/ml, corresponding to 10 μg Hb/g faeces) with intervals of 1 (group I), 2 (group II) or 3 years (group III).
Results In group I, participation was 64.7% in the first screening round and 63.2% in the second. The corresponding percentages for groups II and III were 61.0% vs 62.5% and 62.0% vs 64.0%. Triennial screening resulted in a higher participation rate in the second screening round compared with annual screening (p=0.04). The overall positivity rate in the second screening round was significantly lower compared with the first round (6.0% vs 8.4%; OR 0.69, 95% CI 0.58 to 0.82) and did not depend on interval length (p=0.23). Similarly, the overall detection rate of advanced neoplasia was significantly lower in the second round compared with the first screening round (1.9% vs 3.3%; OR 0.57, 95% CI 0.43 to 0.76) and also did not depend on interval length (p=0.62). The positive predictive value of the FIT did not significantly change over time (41% vs 33%; p=0.07).
Conclusion The total number of advanced neoplasia found at repeat FIT screening is not influenced by the interval length within a range of 1–3 years. Furthermore, there is a stable and acceptably high participation in the second screening round. This implies that screening intervals can be tailored to local resources.
- Colorectal cancer screening
- repeated faecal immunochemical testing
- interval length
- detection rate of advanced neoplasia
- decision analysis
- gastrointestinal cancer
- faecal incontinence
- Helicobacter pylori
Funding This trial was funded by the Dutch Cancer Society (EMCR 2006-3673), the Dutch Ministry of Health, Health Care Prevention Program-Implementation (ZonMw 63300022 and ZonMw 120720011), Olympus Medical Systems Europe GmbH, Hamburg, Germany, the Jacoba Foundation and Eiken Chemical Co, Tokyo, Japan. The funding sources had no influence on study design, data collection, monitoring, analysis and interpretation of results or the decision to submit the manuscript for publication.
Competing interests None.
Ethics approval The study was approved by the Dutch Ministry of Health (PG/ZP 2.727.071 and PG/ZP 2.823.158). The study letters and information brochures were approved by the Institutional Review Board at the Erasmus University Medical Centre (MEC-2005-264 and MEC-2008-029).
Provenance and peer review Not commissioned; externally peer reviewed.