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Published on: June 8, 2020
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Lower Abnormal Fecal Immunochemical Test Cut-Off Values Improve Detection of Colorectal Cancer in System-Level
Emily Berry1, Stacie Miller1, Mark Koch2
1Moncrief Cancer Institute, Fort Worth, Texas.
Summary
Lowering the fecal immunochemical test (FIT) cut-off for hemoglobin to 10 μg/g feces increased advanced neoplasia detection in colorectal cancer screening. This change, however, doubled the need for diagnostic colonoscopies, impacting healthcare resource allocation.
Area of Science:
- Gastroenterology
- Oncology
- Preventive Medicine
Background:
- Noninvasive colorectal cancer (CRC) screening tests like the fecal immunochemical test (FIT) offer higher patient acceptability but lower sensitivity for neoplasia detection compared to colonoscopy.
- Investigating methods to enhance FIT sensitivity is crucial for improving early CRC detection rates.
Purpose of the Study:
- To evaluate the impact of reducing the hemoglobin cut-off concentration for abnormal FIT results on the detection of advanced neoplasia and colorectal cancer (CRC).
- To assess the effect of a lower FIT cut-off on colonoscopy demand and yield in an uninsured patient population.
Main Methods:
- A prospective study involved 17,017 uninsured patients aged 50-64 years undergoing CRC screening.
- The FIT hemoglobin cut-off was lowered from ≥20 μg/g feces to ≥10 μg/g feces.
- Patients with abnormal FIT results received no-cost diagnostic colonoscopies; neoplasia yield and colonoscopy demand were compared between cut-off values.
Main Results:
- Reducing the FIT cut-off to ≥10 μg/g feces increased the proportion of abnormal results (12.3% vs 6.6%) and identified additional cases of advanced neoplasia (10.2% vs 12.7% detection rate, P=.12) and CRC (0.9% vs 1.2%, P=.718).
- The number needed to screen for advanced neoplasia decreased from 58 to 45, but the number needed to scope increased from 4 to 5.
- A significant proportion of advanced adenomas (32.7%) and CRCs (27.3%) were detected in the 10-19 μg/g feces range, which would have been missed with the standard cut-off.
Conclusions:
- Lowering the FIT hemoglobin cut-off to ≥10 μg/g feces can potentially increase the detection of advanced neoplasia and CRC.
- This strategy doubles the demand for diagnostic colonoscopies, necessitating consideration of healthcare system capacity.
- Health systems utilizing quantitative FITs should consider a lower cut-off to optimize CRC detection and prevention, provided colonoscopy resources are adequate.
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