Interval cancers in a national colorectal screening programme based on faecal immunochemical testing: Implications for faecal haemoglobin concentration threshold and sex inequality.
IF 2.6 4区 医学Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Gavin Rc Clark, Thomas Godfrey, Calum Purdie, Judith Strachan, Francis A Carey, Callum G Fraser, Robert Jc Steele
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引用次数: 0
Abstract
Objective: To compare interval cancer proportions (ICP) in the faecal immunochemical test (FIT)-based Scottish Bowel Screening Programme (SBoSP) with the former guaiac faecal occult blood test (gFOBT)-based SBoSP and investigate associations between interval cancer (IC) and faecal haemoglobin concentration (f-Hb) threshold, sex, age, deprivation, site, and stage.
Methods: The ICP data from first year of the FIT-based SBoSP and the penultimate year of the gFOBT-based SBoSP were compared in a prospective cohort design.
Results: With FIT, 801 colorectal cancers (CRCs) were screen detected (SDC), 802 were in non-participants, 548 were ICs, 39 were colonoscopy missed and 72 were diagnosed after incomplete screening; with gFOBT: 540, 904, 556, 45, and 13, respectively. FIT had a significantly higher proportion of SDC compared to IC than gFOBT. For FIT and gFOBT, ICP was significantly higher in women than men. As f-Hb threshold increased, ICP increased and, for any f-Hb threshold for men, a lower threshold was required for comparable ICP in women. In Scotland, the current threshold of ≥80 µg Hb/g faeces would have to be lowered to ≥40 µg Hb/g faeces for women to achieve sex equality for ICP. In the FIT-based SBoSP, there were four times as many stage I SDC than IC. This was reversed in advanced stages, with twice as many stage IV CRC diagnosed as IC versus SDC.
Conclusions: Reducing the numbers of IC requires lowering the f-Hb threshold. Using different f-Hb thresholds for women and men could eliminate the sex disparity, but with additional colonoscopy.
期刊介绍：
Journal of Medical Screening, a fully peer reviewed journal, is concerned with all aspects of medical screening, particularly the publication of research that advances screening theory and practice. The journal aims to increase awareness of the principles of screening (quantitative and statistical aspects), screening techniques and procedures and methodologies from all specialties. An essential subscription for physicians, clinicians and academics with an interest in screening, epidemiology and public health.
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