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Published on: June 8, 2020
A Comparison of Fecal Immunochemical and High-Sensitivity Guaiac Tests for Colorectal Cancer Screening
Jean A Shapiro1, Janet K Bobo2, Timothy R Church3
1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Fecal immunochemical tests (FITs) show higher sensitivity for detecting advanced colorectal neoplasia than the Hemoccult II SENSA (HS-gFOBT). Further research is needed to confirm these findings in larger populations and compare various FITs for colorectal cancer screening.
Area of Science:
- Gastroenterology
- Oncology
- Screening Diagnostics
Background:
- Annual screening for colorectal cancer (CRC) in average-risk individuals is recommended using high-sensitivity guaiac fecal occult blood tests (HS-gFOBT) or fecal immunochemical tests (FIT).
- Comparing the diagnostic performance of different stool-based CRC screening tests is crucial for optimizing population health strategies.
Purpose of the Study:
- To compare the performance characteristics of one HS-gFOBT (Hemoccult II SENSA) and two FITs (InSure FIT, OC FIT-CHEK) for detecting advanced colorectal neoplasia.
- To evaluate the sensitivity and specificity of these tests in an asymptomatic screening population.
Main Methods:
- A study involving 1,006 asymptomatic participants aged 50-75 years undergoing screening colonoscopy.
- Participants completed three stool tests: Hemoccult II SENSA, InSure FIT, and OC FIT-CHEK, prior to colonoscopy.
- Performance characteristics were assessed against colonoscopy results as the gold standard.
Main Results:
- InSure FIT demonstrated the highest sensitivity (26.3%) for advanced colorectal neoplasia, significantly outperforming OC FIT-CHEK (15.1%) and Hemoccult II SENSA (7.4%).
- Specificities for all tested methods remained high, ranging from 96.8% to 98.6%.
- InSure FIT showed a statistically significant increase in sensitivity compared to both other tests.
Conclusions:
- Certain FITs exhibit superior sensitivity compared to HS-gFOBT Hemoccult II SENSA in detecting advanced colorectal neoplasia.
- Further validation in larger asymptomatic cohorts is warranted.
- Additional comparative studies between different FITs are necessary to identify optimal tests for widespread CRC screening programs.
Objectives:
Annual testing using either a high-sensitivity guaiac fecal occult blood test (HS-gFOBT) or a fecal immunochemical test (FIT) is recommended for screening average-risk people for colorectal cancer. We compared the performance characteristics of the HS-gFOBT Hemoccult II SENSA and two FITs (InSure FIT and OC FIT-CHEK) for detecting advanced colorectal neoplasia.
Methods:
The study included 1,006 asymptomatic patients, aged 50-75 years, who were scheduled to receive a screening colonoscopy at gastroenterology practices in the Minneapolis and Indianapolis metropolitan areas. Each participant was asked to complete all three stool tests before their colonoscopy. Each test's performance characteristics were evaluated using the screening colonoscopic results as the reference standard.
Results:
Sensitivity for detecting advanced colorectal neoplasia was highest for InSure FIT (26.3%, 95% confidence interval (CI) 15.9-40.7), followed by OC FIT-CHEK (15.1%, 95% CI 6.7-26.1) and Hemoccult II SENSA (7.4%, 95% CI 1.9-17.0). InSure FIT was statistically significantly more sensitive than both OC FIT-CHEK (absolute difference in sensitivity=11.2%, 95% CI 0.4-24.2) and Hemoccult II SENSA (difference in sensitivity=18.9%, 95% CI 10.2-32.6). Specificities were relatively high for all tests (between 96.8% and 98.6%).
Conclusions:
Our results suggest that some FITs are more sensitive than the HS-gFOBT Hemoccult II SENSA, but these results need to be confirmed in larger asymptomatic populations. Comparisons between the FITs examined in this study and other FITs are needed to determine the best tests for population screening.
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