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  11. Influence Of Varying Quantitative Fecal Immunochemical Test Positivity Thresholds On Colorectal Cancer Detection: A Community-based Cohort Study

Influence of Varying Quantitative Fecal Immunochemical Test Positivity Thresholds on Colorectal Cancer Detection: A Community-Based Cohort Study

Kevin Selby1, Christopher D Jensen1, Jeffrey K Lee1

  • 1Kaiser Permanente Northern California, Oakland, California (K.S., C.D.J., J.K.L., W.K.Z., D.A.C.).

Annals of Internal Medicine
|September 23, 2018

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View abstract on PubMed

Summary
This summary is machine-generated.

Lowering the fecal immunochemical test (FIT) threshold for colorectal cancer screening increases cancer detection but also the number of positive results. Tailoring FIT thresholds by age and sex may improve screening equity.

Area of Science:

  • Gastroenterology
  • Oncology
  • Public Health

Background:

  • The fecal immunochemical test (FIT) is a common tool for colorectal cancer (CRC) screening.
  • Optimal FIT positivity thresholds considering demographic variations in hemoglobin concentrations are not well-established.

Purpose of the Study:

  • To determine the performance characteristics of a multitest FIT program.
  • To identify optimal quantitative hemoglobin positivity thresholds for FIT screening.
  • To analyze FIT performance by age and sex in a large population-based screening program.

Main Methods:

  • Retrospective cohort study of adults aged 50–75 years undergoing FIT screening.
  • Analysis of quantitative FIT results and CRC diagnoses over a 2-year follow-up period.
  • Evaluation of programmatic sensitivity and positive test results per cancer case detected at various FIT thresholds, stratified by age and sex.

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Main Results:

  • Lowering the FIT positivity threshold increased CRC detection rates (e.g., 79.3% sensitivity at 10 µg/g vs. 66.0% at 30 µg/g).
  • Reduced thresholds also increased the number of positive tests per cancer case detected.
  • At a 20 µg/g threshold, screening sensitivity decreased with increasing age and was lower in women compared to men.

Conclusions:

  • While lower FIT thresholds enhance cancer detection, they significantly increase the number of positive tests, necessitating more colonoscopies.
  • Adjusting FIT positivity thresholds based on demographic factors like age and sex could potentially lead to more equitable screening benefits.
  • The optimal threshold strategy depends on balancing cancer detection with resource availability and the need for follow-up procedures.