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Can the performance of a quantitative FIT-based colorectal cancer screening programme be enhanced by lowering the threshold and increasing the interval?
  1. Jayne Digby1,2,
  2. Callum G Fraser1,2,
  3. Frank A Carey3,
  4. Robert J C Steele1,2,4
  1. 1 Scottish Bowel Screening Research Unit, Ninewells Hospital and Medical School, Dundee, UK
  2. 2 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
  3. 3 Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
  4. 4 Division of Cancer, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
  1. Correspondence to Jayne Digby, Scottish Bowel Screening Research Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland; jaynedigby{at}

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We read with interest the work by Haug et al published in Gut.1 Longitudinal data from 4523 participants in the first round of a faecal immunochemical test for haemoglobin (FIT)-based screening programme, of whom 3427 also participated in the second round, were studied. In both first and second rounds, a threshold of 10 µg Hb/g faeces was used. The cohort was followed up for 2 years. The cumulative positivity and the number of participants diagnosed with neoplasia over the two rounds of screening were determined and compared with a hypothetical strategy involving single round screening with use of lower faecal haemoglobin concentration (f-Hb) thresholds and omission of the second round. It was suggested that lowering the f-Hb threshold and extending the screening interval could possibly enhance population-based screening programmes.

In our pilot evaluation of FIT-based screening in Scotland, a much higher f-Hb threshold (≥80 µg Hb/g faeces) was employed.2 …

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  • Contributors JD, CGF and RJCS designed, planned and conducted the work and produced the tables. FAC provided pathology data. All authors contributed to data interpretation and writing of the letter. All authors approved the final draft.

  • Funding Funded by the Chief Scientist Office of the Scottish Government Health Department. Project: Establishing a Bowel Screening Research Unit (Grant Ref: CZH/6/4).

  • Disclaimer The funder had no role in the study design, data collection, statistical analyses, interpretation of the result or writing of the manuscript.

  • Competing interests CGF undertook consultancy with Immunostics Inc, Ocean, New Jersey, USA, and Kyowa-Medex, Tokyo, Japan.

  • Ethics approval Ethical approval was not required for this study as it involved analysis of routinely collected screening data. The FIT pilot was approved by the Programme Board, Scottish Bowel Screening Programme as an evaluation of an established screening modality.

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

  • Data sharing statement No further unpublished data are available to others.

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