Demand for Colonoscopy in Colorectal Cancer Screening Using a Quantitative Fecal Immunochemical Test and Age-Sex-Specific Thresholds for Test Positivity
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Date
2018-06
Authors
Chen, Sam Li-Sheng
Hsu, Chen-Yang
Yen, Amy Ming-Fang
Young, Graeme Paul
Chiu, Sherry Yueh-Hsia
Fann, Jean Ching-Yuan
Lee, Yi-Chia
Chiu, Han-Mo
Chiou, Shu-Ti
Chen, Hsiu-Hsi
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Rights
© 2018 American Association for Cancer Research. This manuscript version is made
available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/
Rights Holder
© 2018 American Association for Cancer Research.
Abstract
Background: Despite age and sex differences in fecal hemoglobin (f-Hb) concentrations, most fecal immunochemical test (FIT) screening programs use population-average cut-points for test positivity. The impact of age/sex-specific threshold on FIT accuracy and colonoscopy demand for colorectal cancer screening are unknown.
Methods: Using data from 723,113 participants enrolled in a Taiwanese population-based colorectal cancer screening with single FIT between 2004 and 2009, sensitivity and specificity were estimated for various f-Hb thresholds for test positivity. This included estimates based on a “universal” threshold, receiver-operating-characteristic curve–derived threshold, targeted sensitivity, targeted false-positive rate, and a colonoscopy-capacity-adjusted method integrating colonoscopy workload with and without age/sex adjustments.
Results: Optimal age/sex-specific thresholds were found to be equal to or lower than the universal 20 μg Hb/g threshold. For older males, a higher threshold (24 μg Hb/g) was identified using a 5% false-positive rate. Importantly, a nonlinear relationship was observed between sensitivity and colonoscopy workload with workload rising disproportionately to sensitivity at 16 μg Hb/g. At this “colonoscopy-capacity-adjusted” threshold, the test positivity (colonoscopy workload) was 4.67% and sensitivity was 79.5%, compared with a lower 4.0% workload and a lower 78.7% sensitivity using 20 μg Hb/g. When constrained on capacity, age/sex-adjusted estimates were generally lower. However, optimizing age/-sex-adjusted thresholds increased colonoscopy demand across models by 17% or greater compared with a universal threshold.
Conclusions: Age/sex-specific thresholds improve FIT accuracy with modest increases in colonoscopy demand.
Impact: Colonoscopy-capacity-adjusted and age/sex-specific f-Hb thresholds may be useful in optimizing individual screening programs based on detection accuracy, population characteristics, and clinical capacity
Description
Keywords
fecal immunochemical test, colonoscopy, colorectal cancer, screening
Citation
Chen, S. L.-S., Hsu, C.-Y., Yen, A. M.-F., Young, G. P., Chiu, S. Y.-H., Fann, J. C.-Y., … Chen, H.-H. (2018). Demand for Colonoscopy in Colorectal Cancer Screening Using a Quantitative Fecal Immunochemical Test and Age/Sex-Specific Thresholds for Test Positivity. Cancer Epidemiology Biomarkers & Prevention, 27(6), 704–709.