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1051. Similar fecal immunochemical test results in screening and referral colorectal cancer.

Author

van Turenhout ST, van Rossum LG, Oort FA, Laheij RJ, van Rijn AF, Terhaar sive Droste JS, Fockens P, van der Hulst RW, Bouman AA, Jansen JB, Meijer GA, Dekker E, and Mulder CJ

Subjects
Aged, Colonoscopy, Colorectal Neoplasms pathology, Female, Humans, Immunohistochemistry, Logistic Models, Male, Middle Aged, Neoplasm Staging, Prospective Studies, Single-Blind Method, Colorectal Neoplasms diagnosis, Mass Screening, Occult Blood, Referral and Consultation
Abstract

Aim: To improve the interpretation of fecal immunochemical test (FIT) results in colorectal cancer (CRC) cases from screening and referral cohorts., Methods: In this comparative observational study, two prospective cohorts of CRC cases were compared. The first cohort was obtained from 10 322 average risk subjects invited for CRC screening with FIT, of which, only subjects with a positive FIT were referred for colonoscopy. The second cohort was obtained from 3637 subjects scheduled for elective colonoscopy with a positive FIT result. The same FIT and positivity threshold (OC sensor; ≥ 50 ng/mL) was used in both cohorts. Colonoscopy was performed in all referral subjects and in FIT positive screening subjects. All CRC cases were selected from both cohorts. Outcome measurements were mean FIT results and FIT scores per tissue tumor stage (T stage)., Results: One hundred and eighteen patients with CRC were included in the present study: 28 cases obtained from the screening cohort (64% male; mean age 65 years, SD 6.5) and 90 cases obtained from the referral cohort (58% male; mean age 69 years, SD 9.8). The mean FIT results found were higher in the referral cohort (829 ± 302 ng/mL vs 613 ± 368 ng/mL, P = 0.02). Tissue tumor stage (T stage) distribution was different between both populations [screening population: 13 (46%) T1, eight (29%) T2, six (21%) T3, one (4%) T4 carcinoma; referral population: 12 (13%) T1, 22 (24%) T2, 52 (58%) T3, four (4%) T4 carcinoma], and higher T stage was significantly associated with higher FIT results (P < 0.001). Per tumor stage, no significant difference in mean FIT results was observed (screening vs referral: T1 498 ± 382 ng/mL vs 725 ± 374 ng/mL, P = 0.22; T2 787 ± 303 ng/mL vs 794 ± 341 ng/mL, P = 0.79; T3 563 ± 368 ng/mL vs 870 ± 258 ng/mL, P = 0.13; T4 not available). After correction for T stage in logistic regression analysis, no significant differences in mean FIT results were observed between both types of cohorts (P = 0.10)., Conclusion: Differences in T stage distribution largely explain differences in FIT results between screening and referral cohorts. Therefore, FIT results should be reported according to T stage.

Published
2012
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1052. Advances in Fecal Tests for Colorectal Cancer Screening

Author

Eline H. Schreuders, Manon C.W. Spaander, Esmée J. Grobbee, and Ernst J. Kuipers

Subjects
Oncology, medicine.medical_specialty, Pathology, Colorectal cancer, Colonoscopy, Colorectal cancer screening, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Feces, Guaiac fecal occult blood test, medicine.diagnostic_test, Colon (C Kahi, Section Editor), gFOBT, business.industry, Fecal immunochemical test, Incidence (epidemiology), Fecal occult blood, Gastroenterology, Cancer, Biomarker, medicine.disease, FIT, DNA testing, digestive system diseases, 030220 oncology & carcinogenesis, Biomarker (medicine), 030211 gastroenterology & hepatology, business
Abstract

Opinion statement Colorectal cancer (CRC) forms an important public health problem, especially in developed countries. CRC screening tests can be used to identify asymptomatic individuals with CRC precursors and (early) cancer. Removal of these lesions reduces CRC incidence and prevents CRC-related mortality. There are a range of screening tests available, each with advantages and disadvantages. Stool screening tests can broadly be divided into fecal occult blood tests (FOBTs) and molecular biomarker test, such as DNA/RNA marker tests, protein markers, and fecal microbiome marker tests. Guaiac fecal occult blood tests (gFOBT) have been demonstrated in large randomized screening trials to reduce CRC mortality. Fecal immunochemical tests (FIT) have superior adherence, usability, and accuracy as compared to gFOBT. Advantage of the use of quantitative FITs in CRC screening programs is the cut-off level that can be adjusted. Molecular biomarker DNA tests have shown to detect significantly more cancers than FIT. By combining biomarker DNA tests with FIT, sensitivity for advanced adenomas can be increased significantly. However, it has lower specificity thus demands more colonoscopy resources, is more cumbersome, and costly. The adherence has not been assessed in population screening trials. For these reasons, FIT is therefore at present regarded as the preferred method of non-invasive CRC screening. This chapter will review the current status of fecal test-based CRC screening.

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1053. [Untitled]

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Stool test, Colorectal cancer, Gastroenterology, Colonoscopy, Cancer, General Medicine, medicine.disease, Patient preference, Home based, digestive system diseases, 03 medical and health sciences, 0302 clinical medicine, Fecal Immunochemical Test, 030220 oncology & carcinogenesis, Internal medicine, Medicine, 030211 gastroenterology & hepatology, business, Intermediate risk
Abstract

Background To assess public preferences for colorectal cancer (CRC) surveillance tests for intermediate-risk adenomas, using a hypothetical scenario.

1054. Incidence trends of colorectal cancer in the early 2000s in Italy. Figures from the IMPATTO study on colorectal cancer screening

Author

Zorzi, M., Mangone, L., Sassatelli, R., Baracco, S., Budroni, M., Castaing, M., Cirilli, C., Cusimano, R., Fusco, M., Giacomin, A., Rossi, P. G., Naldoni, C., Pannozzo, F., Piffer, S., Puppo, A., Tisano, F., Zappa, M., Azzoni, A., Baldazzi, P., Collina, N., Pandolfi, P., Petrucci, C., Gualandi, G., Sciacchitano, S., Ieni, A., Bella, F., Torrisi, A., Varvarà, M., Finarelli, A. C., Bianchi, P. S., Landi, P., Ferretti, S., Matarese, V., Togni, A., Palmonari, C., Caldarella, A., Crocetti, E., Grazzini, G., Manneschi, G., Mantellini, P., Serraino, D., Bidoli, E., Taborelli, M., Gini, A., Virdone, S., Casella, C., Celesia, M., Cogno, R., Marani, E., Busco, S., Bernazza, E., Curatella, S., Macci, L., Rossi, M., Randi, G., Frammartino, B., Bonini, A., Filippazzi, L., Giubelli, C., Corradini, R., Girolamo, F., Valla, K., Palombino, R., D Orsi, M., Isernia, M., Vitale, F. M., Adamo, M. S., Amodio, R., Brucculeri, A., Guttadauro, A., WALTER MAZZUCCO, Sgarzi, P., Bozzani, F., Zatelli, M., Zurlini, C., Caruana, P., Borciani, E., Gatti, G., Prazzoli, R., Seghini, P., Campari, C., Di Felice, E., Sacchettini, C., Cassetti, T., Falcini, F., Mancini, S., Vattiato, R., Giuliani, O., Caprara, L., Cesaraccio, R., Sechi, O., Madeddu, A., Contrino, M. L., Colanino Ziino, A., Russo, M., Fanetti, A. C., Maspero, S., Moroni, E., Cometti, I., Gentilini, M., Pretis, G., Caciagli, P., Pertile, R., Bianconi, F., Masanotti, G. M., Lio, M. C., Leite, S., Passamonti, B. U., Dei Tos, A. P., Rosano, A., Monetti, D., Guzzinati, S., Tognazzo, S., Zorzi, M., Mangone, L., Sassatelli, R., Baracco, S., Budroni, M., Castaing, M., Cirilli, C., Cusimano, R., Fusco, M., Giacomin, A., Rossi, P., Naldoni, C., Pannozzo, F., Piffer, S., Puppo, A., Tisano, F., Zappa, M., Azzoni, A., Baldazzi, P., Collina, N., Pandolfi, P., Petrucci, C., Gualandi, G., Sciacchitano, S., Ieni, A., Bella, F., Torrisi, A., Varvarã , M., Finarelli, A., De Bianchi, P., Landi, P., Ferretti, S., Matarese, V., De Togni, A., Palmonari, C., Caldarella, A., Crocetti, E., Grazzini, G., Manneschi, G., Mantellini, P., Serraino, D., Bidoli, E., Taborelli, M., Gini, A., Virdone, S., Casella, C., Celesia, M., Cogno, R., Marani, E., Busco, S., Bernazza, E., Curatella, S., Macci, L., Rossi, M., Randi, G., Frammartino, B., Bonini, A., Filippazzi, L., Giubelli, C., Corradini, R., De Girolamo, F., Valla, K., Palombino, R., D'Orsi, M., Isernia, M., Fusco, E., Vitale, F., Adamo, M., Amodio, R., Brucculeri, A., Guttadauro, A., Mazzucco, W., Sgarzi, P., Bozzani, F., Zatelli, M., Zurlini, C., Caruana, P., Borciani, E., Gatti, G., Prazzoli, R., Seghini, P., Campari, C., Di Felice, E., Sacchettini, C., Cassetti, T., Falcini, F., Mancini, S., Vattiato, R., Giuliani, O., Caprara, L., Cesaraccio, R., Sechi, O., Madeddu, A., Contrino, M., Colanino Ziino, A., Russo, M., Fanetti, A., Maspero, S., Moroni, E., Cometti, I., Gentilini, M., De Pretis, G., Caciagli, P., Pertile, R., Bianconi, F., Masanotti, G., De Lio, M., Leite, S., Passamonti, B., Dei Tos, A., Rosano, A., Monetti, D., Guzzinati, S., and Tognazzo, S.

Subjects
Colorectal cancer, Fecal immunochemical test, Incidence rates, Italy, Screening, Epidemiology, Public Health, Environmental and Occupational Health, Environmental and Occupational Health, Socio-culturale, Public Health, Incidence rate, Settore MED/42 - Igiene Generale E Applicata
Abstract

We utilised the IMPATTO study's archives to describe the 2000-2008 colorectal cancer (CRC) incidence rate trends in Italy, once screening programmes based on the faecal immunochemical test were implemented in different areas. Data on CRCs diagnosed in Italy from 2000 to 2008 in subjects aged 40-79 years were collected by 23 cancer registries. Incidence rate trends were evaluated as a whole and by macro-area (North-Centre and South-Islands), presence of a screening programme, sex, ten-year age class, anatomic site, stage at diagnosis, and pattern of diagnosis (screen-detected, non-screen-detected). The annual percent change (APC) of incidence rate trends, with 95% confidence intervals (95%CI), were computed. The study included 46,857 CRCs diagnosed in subjects aged 40-79 years, of which 2,806 were screendetected. The incidence rates in the North-Centre were higher than in the South and on the Islands. During the study period, screening programmes had been implemented only in the North-Centre and had a significant effect on incidence rates, with an initial sharp increase in incidence, followed by a decrease that started in the 3rd-4th years of screening. These incidence rate trends were exclusively due to modifications in the rates of stage I cases. After screening programmes started, incidence increased in all anatomic sites, particularly in the distal colon. The differential figures introduced by the implementation of screening programmes warrant a continuous surveillance of CRC incidence and mortality trends to monitor the impact of screening at a national level.

1055. Comparison of patient preferences for fecal immunochemical test or colonoscopy using the analytic hierarchy process

Author

Yinghui Xu, Jeffrey C Dunkelberg, Jeanette M. Daly, George R. Bergus, and Barcey T. Levy

Subjects
Male, Risk, medicine.medical_specialty, Decision Making, Analytic Hierarchy Process (AHP), Analytic hierarchy process, Colonoscopy, Colorectal cancer screening, Feces, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Internal medicine, medicine, Humans, Mass Screening, 030212 general & internal medicine, Early Detection of Cancer, Mass screening, Aged, Gynecology, medicine.diagnostic_test, Fecal immunochemical test, business.industry, Immunochemistry, Health Policy, Patient Preference, Middle Aged, Iowa, Patient preference, 3. Good health, Fecal Immunochemical Test, Occult Blood, 030220 oncology & carcinogenesis, Female, Colorectal Neoplasms, business, Research Article
Abstract

Background In average-risk individuals aged 50 to 75 years, there is no difference in life-years gained when comparing colonoscopy every 10 years vs. annual fecal immunochemical testing (FIT) for colorectal cancer screening. Little is known about the preferences of patients when they have experienced both tests. Methods The study was conducted with 954 patients from the University of Iowa Hospital and Clinics during 2010 to 2011. Patients scheduled for a colonoscopy were asked to complete a FIT before the colonoscopy preparation. Following both tests, patients completed a questionnaire which was based on an analytic hierarchy process (AHP) decision-making model. Results In the AHP analysis, the test accuracy was given the highest priority (0.457), followed by complications (0.321), and test preparation (0.223). Patients preferred colonoscopy (0.599) compared with FIT (0.401) when considering accuracy; preferred FIT (0.589) compared with colonoscopy (0.411) when considering avoiding complications; and preferred FIT (0.650) compared with colonoscopy (0.350) when considering test preparation. The overall aggregated priorities were 0.517 for FIT, and 0.483 for colonoscopy, indicating patients slightly preferred FIT over colonoscopy. Patients’ preferences were significantly different before and after provision of detailed information on test features (p

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