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Increased uptake and improved outcomes of bowel cancer screening with a faecal immunochemical test: results from a pilot study within the national screening programme in England
  1. Sue Moss1,
  2. Christopher Mathews1,
  3. T J Day2,
  4. Steve Smith3,
  5. Helen E Seaman4,
  6. Julia Snowball4,
  7. Stephen P Halloran4,5
  1. 1Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
  2. 2NHS Cancer Screening Programmes, Sheffield, UK
  3. 3NHS Bowel Cancer Screening Midlands and North West Programme Hub, Rugby, UK
  4. 4NHS Bowel Cancer Screening Southern Programme Hub, Guildford, UK
  5. 5University of Surrey, Guildford, UK
  1. Correspondence to Professor Sue Moss, Centre for Cancer Prevention, Queen Mary University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK; s.moss{at}qmul.ac.uk

Abstract

Background The National Health Service Bowel Cancer Screening Programme (BCSP) in England uses a guaiac-based faecal occult blood test (gFOBt). A quantitative faecal immunochemical test (FIT) for haemoglobin (Hb) has many advantages, including being specific for human blood, detecting Hb at a much lower concentration with a single faecal sample and improved uptake.

Methods In 2014, a large comparative pilot study was performed within BCSP to establish the acceptability and diagnostic performance of FIT. Over a 6-month period, 40 930 (1 in 28) subjects were sent a FIT (OC-SENSOR) instead of a gFOBt. A bespoke FIT package was used to mail FIT sampling devices to and from FIT subjects. All participants positive with either gFOBt or FIT (cut-off 20 µg Hb/g faeces) were referred for follow-up. Subgroup analysis included cut-off concentrations, age, sex, screening history and deprivation quintile.

Results While overall uptake increased by over 7 percentage points with FIT (66.4% vs 59.3%, OR 1.35, 95% CI 1.33 to 1.38), uptake by previous non-responders almost doubled (FIT 23.9% vs gFOBt 12.5%, OR 2.20, 95% CI 2.10 to 2.29). The increase in overall uptake was significantly higher in men than women and was observed across all deprivation quintiles. With the conventional 20 µg/g cut-off, FIT positivity was 7.8% and ranged from 5.7% in 59–64-year-old women to 11.1% in 70–75-year-old men. Cancer detection increased twofold and that for advanced adenomas nearly fivefold. Detection rates remained higher with FIT for advanced adenomas, even at 180 µg Hb/g.

Conclusions Markedly improved participation rates were achieved in a mature gFOBt-based national screening programme and disparities between men and women were reduced. High positivity rates, particularly in men and previous non-respondents, challenge the available colonoscopy resource, but improvements in neoplasia detection are still achievable within this limited resource.

  • COLORECTAL CANCER SCREENING
  • EPIDEMIOLOGY
  • COLORECTAL NEOPLASIA
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