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Original Article
Long-term performance of colorectal cancer screening programmes based on the faecal immunochemical test
  1. Manuel Zorzi1,
  2. Cesare Hassan2,
  3. Giulia Capodaglio3,
  4. Chiara Fedato4,
  5. Adriana Montaguti4,
  6. Anna Turrin4,
  7. Alberto Rosano1,
  8. Daniele Monetti1,
  9. Carmen Stocco1,
  10. Susanna Baracco1,
  11. Francesca Russo4,
  12. Alessandro Repici5,
  13. Massimo Rugge6
  1. 1Registro Tumori del Veneto, Regione del Veneto, Padova, Italy
  2. 2Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
  3. 3Sistema Epidemiologico Regionale, Regione del Veneto, Padova, Italy
  4. 4Settore promozione e sviluppo igiene e sanità pubblica, Regione del Veneto, Venezia, Italy
  5. 5Gastroenterology and Endoscopy Unit, Istituto Clinico Humanitas, Rozzano, Italy
  6. 6Department of Medicine DIMED Pathology and Cytopathology Unit, University of Padova e Registro Tumori del Veneto, Regione del Veneto, Padova, Italy
  1. Correspondence to Dr Cesare Hassan, Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome 00153, Italy; cesareh{at}hotmail.com

Abstract

Background The long-term performance of colorectal cancer (CRC) screening programmes based on a 2-year faecal immunochemical test (FIT) is still unclear.

Methods In a sample of 50 to 69-year-olds repeatedly screened with the FIT (OC-Hemodia latex agglutination test; cut-off: 20 µg haemoglobin/g faeces), we examined: (1) the FIT positivity rate, the CRC and advanced adenoma detection rate and the FIT’s positive predictive value (PPV) for advanced neoplasia, at each round of screening and (2) the cumulative CRC and advanced adenoma detection rate after five rounds of FIT.

Results Over 12 years (2002–2014), 123 347 individuals were administered the FIT up to six times, and 781 CRCs and 4713 advanced adenomas were diagnosed. The CRC and advanced adenoma detection rates declined substantially from the first to the third (rate ratio (RR) 0.25, 95% CI 0.20 to 0.32) and second (RR 0.51, 95% CI 0.47 to 0.56) rounds, respectively, and then remained stable. The PPV for advanced neoplasia dropped by 18% in the second round (RR 0.82, 95% CI 0.77 to 0.89), with no further reduction thereafter due to a concomitant decline in the FIT positivity rate (RR first to sixth rounds: 0.56, 95% CI 0.53 to 0.60).

The cumulative CRC and advanced adenoma detection rates over five consecutive rounds were 8.5‰ (95% CI 7.8 to 9.2), and 58.9‰ (95% CI 56.9 to 61.0), respectively.

Conclusions Repeated FIT significantly reduces the burden of colorectal disease while facilitating an efficient use of colonoscopy resources. The cumulative detection rate after five rounds of FIT is similar to primary screening with colonoscopy, supporting the need to account for the cumulative sensitivity of repeated FITs when evaluating the test’s efficacy.

  • colorectal cancer screening
  • colorectal cancer
  • colonic neoplasms
  • colonic polyps
  • colonoscopy

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Footnotes

  • Contributors MZ, MR: study concept and design; MZ, GC: analysis of data; MZ, CH: drafting of the manuscript; all authors: critical revision of the manuscript for content.

  • Competing interests None declared.

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

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