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Clark GRC, Godfrey T, Purdie C, Strachan J, Carey FA, Fraser CG, Steele RJC. Interval cancers in a national colorectal screening programme based on faecal immunochemical testing: Implications for faecal haemoglobin concentration threshold and sex inequality. J Med Screen 2024; 31:21-27. [PMID: 37469171 PMCID: PMC10878005 DOI: 10.1177/09691413231188252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
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.
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Affiliation(s)
- Gavin RC Clark
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Public Health Scotland, Edinburgh, UK
| | | | | | - Judith Strachan
- Blood Sciences and Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, UK
| | - Francis A Carey
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Robert JC Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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2
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Vanaclocha-Espí M, Pinto-Carbó M, Ibáñez J, Valverde-Roig MJ, Portillo I, Pérez-Riquelme F, de la Vega M, Castán-Cameo S, Salas D, Molina-Barceló A. Interval Cancer in Population-Based Colorectal Screening Programmes: Incidence and Characteristics of Tumours. Cancers (Basel) 2024; 16:769. [PMID: 38398160 PMCID: PMC10887036 DOI: 10.3390/cancers16040769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
The objective of this study is to evaluate interval cancer (IC) in colorectal cancer (CRC) screening, which is CRC diagnosed in an individual after having received a negative faecal occult blood test and before the next invitation to participate in screening. A follow-up study was conducted on a cohort of participants in the first three screening rounds of four colorectal cancer screening programmes in Spain, n = 664,993. A total of 321 ICs and 2120 screen-detected cancers (SCs) were found. The IC and SC rates were calculated for each guaiac (gFOBT) or immunochemical (FIT) test. A Cox regression model was used to estimate the hazard ratios (HR) of IC risk factors. A nested case-control study was carried out to compare IC and SC tumour characteristics. The IC rate was 1.16‱ with the gFOBT and 0.35‱ with the FIT. Men and people aged 60-69 showed an increased probability of IC (HR = 1.81 and HR = 1.95, respectively). There was a decreased probability of IC in individuals who regularly participated in screening, HR = 0.62 (0.47-0.82). IC risk gradually rose as the amount of Hb detected in the FIT increased. IC tumours were in more advanced stages and of a larger size than SC tumours, and they were mostly located in the cecum. These results may play a key role in future strategies for screening programmes, reducing IC incidence.
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Affiliation(s)
- Mercedes Vanaclocha-Espí
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Community (FISABIO)–Public Health, 46020 Valencia, Spain (A.M.-B.)
| | - Marina Pinto-Carbó
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Community (FISABIO)–Public Health, 46020 Valencia, Spain (A.M.-B.)
| | - Josefa Ibáñez
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Community (FISABIO)–Public Health, 46020 Valencia, Spain (A.M.-B.)
- General Directorate of Public Health, Valencian Community, 46020 Valencia, Spain
| | | | | | | | - Mariola de la Vega
- General Directorate of Assistance Programmes, 38071 Santa Cruz de Tenerife, Spain
| | - Susana Castán-Cameo
- General Directorate of Public Health, Valencian Community, 46020 Valencia, Spain
| | - Dolores Salas
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Community (FISABIO)–Public Health, 46020 Valencia, Spain (A.M.-B.)
- General Directorate of Public Health, Valencian Community, 46020 Valencia, Spain
| | - Ana Molina-Barceló
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Community (FISABIO)–Public Health, 46020 Valencia, Spain (A.M.-B.)
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3
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Bresalier RS, Senore C, Young GP, Allison J, Benamouzig R, Benton S, Bossuyt PMM, Caro L, Carvalho B, Chiu HM, Coupé VMH, de Klaver W, de Klerk CM, Dekker E, Dolwani S, Fraser CG, Grady W, Guittet L, Gupta S, Halloran SP, Haug U, Hoff G, Itzkowitz S, Kortlever T, Koulaouzidis A, Ladabaum U, Lauby-Secretan B, Leja M, Levin B, Levin TR, Macrae F, Meijer GA, Melson J, O'Morain C, Parry S, Rabeneck L, Ransohoff DF, Sáenz R, Saito H, Sanduleanu-Dascalescu S, Schoen RE, Selby K, Singh H, Steele RJC, Sung JJY, Symonds EL, Winawer SJ. An efficient strategy for evaluating new non-invasive screening tests for colorectal cancer: the guiding principles. Gut 2023; 72:1904-1918. [PMID: 37463757 PMCID: PMC10511996 DOI: 10.1136/gutjnl-2023-329701] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE New screening tests for colorectal cancer (CRC) are rapidly emerging. Conducting trials with mortality reduction as the end point supporting their adoption is challenging. We re-examined the principles underlying evaluation of new non-invasive tests in view of technological developments and identification of new biomarkers. DESIGN A formal consensus approach involving a multidisciplinary expert panel revised eight previously established principles. RESULTS Twelve newly stated principles emerged. Effectiveness of a new test can be evaluated by comparison with a proven comparator non-invasive test. The faecal immunochemical test is now considered the appropriate comparator, while colonoscopy remains the diagnostic standard. For a new test to be able to meet differing screening goals and regulatory requirements, flexibility to adjust its positivity threshold is desirable. A rigorous and efficient four-phased approach is proposed, commencing with small studies assessing the test's ability to discriminate between CRC and non-cancer states (phase I), followed by prospective estimation of accuracy across the continuum of neoplastic lesions in neoplasia-enriched populations (phase II). If these show promise, a provisional test positivity threshold is set before evaluation in typical screening populations. Phase III prospective studies determine single round intention-to-screen programme outcomes and confirm the test positivity threshold. Phase IV studies involve evaluation over repeated screening rounds with monitoring for missed lesions. Phases III and IV findings will provide the real-world data required to model test impact on CRC mortality and incidence. CONCLUSION New non-invasive tests can be efficiently evaluated by a rigorous phased comparative approach, generating data from unbiased populations that inform predictions of their health impact.
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Affiliation(s)
- Robert S Bresalier
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlo Senore
- Epidemiology and screening unit, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte, Turin, Italy
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - James Allison
- Internal Medicine/Division of Gastroenterology, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Robert Benamouzig
- Gastroenterology & Digestive Oncology Department, Hôpital Avicenne University Paris Nord La Sorbonne, Bobigny, France
| | - Sally Benton
- Department of Clinical Biochemistry and NHS Bowel Cancer Screening South of England Hub, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - Patrick M M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Luis Caro
- Carrera de especialista de Endoscopia Digestiva, Institución GEDYT (Gastroenterologia diagnostico y terapéutica), Buenos Aires, Argentina
| | - Beatriz Carvalho
- Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Han-Mo Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Veerle M H Coupé
- Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Willemijn de Klaver
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Clasine Maria de Klerk
- Department of Gastroenterology and Hepatology C2-310, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology C2-115, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Sunil Dolwani
- Dept of Gastroenterology, Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee School of Medicine, Dundee, UK
| | - William Grady
- Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Lydia Guittet
- ERI3 Cancers & Populations, Normandie University, UNICAEN, Caen, France
| | - Samir Gupta
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Ulrike Haug
- Division of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Geir Hoff
- Department of Research, Telemark Hospital, Skien, Norway
- Department of CRC screening, Cancer Registry of Norway, Oslo, Norway
| | - Steven Itzkowitz
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tim Kortlever
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | | | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Beatrice Lauby-Secretan
- Section of Evidence Synthesis and Classification, International Agency for Research on Cancer, Lyon, France
| | - Mārcis Leja
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Bernard Levin
- Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Finlay Macrae
- Colorectal Medicine and Genetics, The University of Melbourne Department of Medicine Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Gerrit A Meijer
- Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joshua Melson
- High-Risk Clinic for Gastrointestinal Cancers, University of Arizona Cancer Center Division of Gastroenterology, Banner University, Tucson, Arizona, USA
| | - Colm O'Morain
- Gastroenterology, Trinity College Dublin Faculty of Health Sciences, Dublin, Ireland
| | - Susan Parry
- National Bowel Screening Programme, National Screening Unit, Te Whatu Ora Health New Zealand, Auckland, New Zealand
- Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Linda Rabeneck
- Department of Medicine, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - David F Ransohoff
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Roque Sáenz
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago de Chile, Chile
| | - Hiroshi Saito
- Department of Gastroenterology, Aomori Prefectural Central Hospital, Aomori, Japan
| | | | - Robert E Schoen
- Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kevin Selby
- Department of ambulatory Care, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Harminder Singh
- Internal Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | | | - Joseph J Y Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Erin Leigh Symonds
- Department of Gastroenterology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sidney J Winawer
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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4
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Deding U, Kobaek-Larsen M, Bøggild H, Kaalby L, Thygesen MK, Baatrup G. Socioeconomic inequalities in interval colorectal cancer are explained by differences in faecal haemoglobin concentration and age: a register-based cohort study. BMJ Open Gastroenterol 2023; 10:bmjgast-2023-001113. [PMID: 37230536 DOI: 10.1136/bmjgast-2023-001113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To estimate the risk of interval colorectal cancer (CRC) in faecal immunochemical test (FIT) negative screening participants according to socioeconomic status. DESIGN In this register-based study, first round FIT negative (<20 µg hb/g faeces) screening participants (biennial FIT, citizens aged 50-74) were followed to estimate interval CRC risk. Multivariate Cox proportional hazard regression models estimated HRs based on socioeconomic status defined by educational level and income. Models were adjusted for age, sex and FIT concentration. RESULTS We identified 829 (0.7‰) interval CRC in 1 160 902 individuals. Interval CRC was more common in lower socioeconomic strata with 0.7‰ for medium-long higher education compared with 1.0‰ for elementary school and 0.4‰ in the highest income quartile compared with 1.2‰ in the lowest. These differences did not translate into significant differences in HR in the multivariate analysis, as they were explained by FIT concentration and age. HR for interval CRC was 7.09 (95% CI) for FIT concentrations 11.9-19.8 µg hb/g faeces, and 3.37 (95% CI) for FIT between 7.2 and 11.8 compared with those <7.2. The HR rose with increasing age ranging from 2.06 (95% CI 1.45 to 2.93) to 7.60 (95% CI 5.63 to 10.25) compared with those under 55 years. CONCLUSION Interval CRC risk increased with decreasing income, heavily influenced by lower income individuals more often being older and having increased FIT concentrations. Individualising screening interval based on age and FIT result, may decrease interval CRC rates, reduce the social gradient and thereby increase the screening efficiency.
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Affiliation(s)
- Ulrik Deding
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Morten Kobaek-Larsen
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Bøggild
- Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Aalborg, Denmark
| | - Lasse Kaalby
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Kirstine Thygesen
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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5
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Koïvogui A, Vincelet C, Abihsera G, Ait-Hadad H, Delattre H, Le Trung T, Bernoux A, Carroll R, Nicolet J. Supply and quality of colonoscopy according to the characteristics of gastroenterologists in the French population-based colorectal-cancer screening program. World J Gastroenterol 2023; 29:1492-1508. [PMID: 36998423 PMCID: PMC10044857 DOI: 10.3748/wjg.v29.i9.1492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Since its complete roll-out in 2009, the French colorectal cancer screening program (CRCSP) experienced 3 major constraints [use of a less efficient Guaiac-test (gFOBT), stopping the supply of Fecal-Immunochemical-Test kits (FIT), and suspension of the program due to the coronavirus disease 2019 (COVID-19)] affecting its effectiveness.
AIM To describe the impact of the constraints in terms of changes in the quality of screening-colonoscopy (Quali-Colo).
METHODS This retrospective cohort study included screening-colonoscopies performed by gastroenterologists between Jan-2010 and Dec-2020 in people aged 50-74 living in Ile-de-France (France). The changes in Quali-colo (Proportion of colonoscopies performed beyond 7 mo (Colo_7 mo), Frequency of serious adverse events (SAE) and Colonoscopy detection rate) were described in a cohort of Gastroenterologists who performed at least one colonoscopy over each of the four periods defined according to the chronology of the constraints [gFOBT: Normal progress of the CRCSP using gFOBT (2010-2014); FIT: Normal progress of the CRCSP using FIT (2015-2018); STOP-FIT: Year (2019) during which the CRCSP experienced the cessation of the supply of test kits; COVID: Program suspension due to the COVID-19 health crisis (2020)]. The link between each dependent variable (Colo_7 mo; SAE occurrence, neoplasm detection rate) and the predictive factors was analyzed in a two-level multivariate hierarchical model.
RESULTS The 533 gastroenterologists (cohort) achieved 21509 screening colonoscopies over gFOBT period, 38352 over FIT, 7342 over STOP-FIT and 7995 over COVID period. The frequency of SAE did not change between periods (gFOBT: 0.3%; FIT: 0.3%; STOP-FIT: 0.3%; and COVID: 0.2%; P = 0.10). The risk of Colo_7 mo doubled between FIT [adjusted odds ratio (aOR): 1.2 (1.1; 1.2)] and STOP-FIT [aOR: 2.4 (2.1; 2.6)]; then, decreased by 40% between STOP-FIT and COVID [aOR: 2.0 (1.8; 2.2)]. Regardless of the period, this Colo_7 mo’s risk was twice as high for screening colonoscopy performed in a public hospital [aOR: 2.1 (1.3; 3.6)] compared to screening-colonoscopy performed in a private clinic. The neoplasm detection, which increased by 60% between gFOBT and FIT [aOR: 1.6 (1.5; 1.7)], decreased by 40% between FIT and COVID [aOR: 1.1 (1.0; 1.3)].
CONCLUSION The constraints likely affected the time-to-colonoscopy as well as the colonoscopy detection rate without impacting the SAE’s occurrence, highlighting the need for a respectable reference time-to-colonoscopy in CRCSP.
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Affiliation(s)
- Akoï Koïvogui
- Site de Seine-Saint-Denis, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Bondy 93146, France
| | - Catherine Vincelet
- Site des Yvelines, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Le Chesnay Cedex 78153, France
| | - Gaëlle Abihsera
- Site du Val-de-Marne, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Joinville-le-Pont 94340, France
| | - Hamou Ait-Hadad
- Site de Seine-et-Marne, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Lieusaint 77763, France
| | - Hélène Delattre
- Site des Hauts-de-Seine, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Nanterre 92000, France
| | - Tu Le Trung
- site du Val-d’Oise, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Cergy Saint-Christophe 95800, France
| | - Agnès Bernoux
- Site de l’Essonne, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Fontenay-Les-Briis 91640, France
| | - Rachel Carroll
- Site du Val-de-Marne, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Joinville-le-Pont 94340, France
| | - Jérôme Nicolet
- Siège Paris, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France (CRCDC-IDF), Paris 75015, France
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Farber R, Houssami N, Barnes I, McGeechan K, Barratt A, Bell KJL. Considerations for Evaluating the Introduction of New Cancer Screening Technology: Use of Interval Cancers to Assess Potential Benefits and Harms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14647. [PMID: 36429373 PMCID: PMC9691207 DOI: 10.3390/ijerph192214647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
This framework focuses on the importance of the consideration of the downstream intermediate and long-term health outcomes when a change to a screening program is introduced. The authors present a methodology for utilising the relationship between screen-detected and interval cancer rates to infer the benefits and harms associated with a change to the program. A review of the previous use of these measures in the literature is presented. The framework presents other aspects to consider when utilizing this methodology, and builds upon an existing framework that helps researchers, clinicians, and policy makers to consider the impacts of changes to screening programs on health outcomes. It is hoped that this research will inform future evaluative studies to assess the benefits and harms of changes to screening programs.
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Affiliation(s)
- Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Isabelle Barnes
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Centre for Women’s Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan 2308, Australia
- Australian Longitudinal Study on Women’s Health, The University of Newcastle, Callaghan 2308, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Katy J. L. Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
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7
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Ribbing Wilén H, Saraste D, Blom J. Interval cancers in a population-based screening program for colorectal cancer with gender-specific cut-off levels for fecal immunochemical test. J Med Screen 2022; 29:156-165. [PMID: 35257615 PMCID: PMC9381686 DOI: 10.1177/09691413221085218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To evaluate interval cancers (IC) in the population-based Swedish regional colorectal cancer (CRC) screening program of Stockholm-Gotland, which uses gender-specific cut-off levels for the fecal immunochemical test (FIT). Methods All individuals aged 60–69 in Stockholm-Gotland invited to the screening program in October 2015 to September 2017 were followed up 2 years after invitation. Cut-off level for a positive FIT was 40 µg/g in women and 80 µg/g in men. Those with a positive FIT were referred to colonoscopy. Screening-detected CRC (SD-CRC) and IC after negative FIT (FIT-IC) or negative screening colonoscopy (Colonoscopy-IC) were identified in the Swedish colorectal cancer register. The IC rate was calculated as IC/(FIT negatives + negative screening colonoscopies). The IC incidence rate (ICs among negatives per 100,000 person-years) in different sex and age groups was compared to the mean CRC incidence before regional screening implementation. Test sensitivity was defined as SD-CRC/(SD-CRC + FIT-IC). Results Approximately 214,400 individuals were invited, and in 3521 screening colonoscopies 257(6.3%) SD-CRCs were detected. During follow-up, 124 FIT-IC and 7 Colonoscopy-IC were diagnosed, yielding an IC rate of 12.6 and 6.0 per 10,000 negatives (p = 0.00005) and a test sensitivity of 62% and 75% (p = 0.01) in men and women respectively. The IC incidence rate compared to CRC incidence was non-significantly lower in women. Conclusion In the population-based screening program of Stockholm-Gotland with a cut-off of 40 µg/g in women and 80 µg/g in men, the test sensitivity was higher and the IC rate was lower in women, which might imply lowering the cut-off level in men. However, the IC incidence rate relative to the CRC incidence was similar in both genders.
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Affiliation(s)
- Hanna Ribbing Wilén
- Department of Clinical Science and Education Södersjukhuset (KI SÖS), 27106Karolinska Institutet, Stockholm, Sweden
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8
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Ibáñez-Sanz G, Milà N, Vives N, Vidal C, Binefa G, Rocamora J, Atencia C, Moreno V, Sanz-Pamplona R, Garcia M. Diagnostic Performance of a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program According to Ambient Temperature and Humidity. Cancers (Basel) 2022; 14:cancers14051153. [PMID: 35267461 PMCID: PMC8909312 DOI: 10.3390/cancers14051153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 02/05/2023] Open
Abstract
Exposure of the fecal immunochemical test (FIT) to different ambient temperatures and humidity is unavoidable in population-based screening programs in Southern European countries, and it could lead to a decrease in target colorectal lesions. The objective was to evaluate the effect of ambient temperature and humidity on the FIT sensitivity in a population-based screening program for colorectal cancer (CRC) using an ecological design. The retrospective cohort included individuals aged 50−69 years who participated in CRC screening (Barcelona) from 2010−2015, and were followed until 2017 to identify interval CRCs. The positivity rate, and detection rates for advanced polyps and CRC were compared according to ambient temperature, humidity, and quarters of the year. A positive FIT was defined as the detection of ≥20 μg Hb/g in feces. The monthly ambient temperature and humidity were recorded on the day that the FIT was performed. In total, 92,273 FIT results from 53,860 participants were analyzed. The FIT positivity rate was lower at >24 °C than at ≤24 °C (p = 0.005) but was not affected by humidity. The temperature’s impact on positivity did not lead to a decrease in the FIT detection rate for advanced neoplasia or the interval cancer detection rate in a program where the samples were refrigerated until the analysis and screening invitations were discontinued in July and August.
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Affiliation(s)
- Gemma Ibáñez-Sanz
- Oncology Data Analytics Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (G.I.-S.); (J.R.); (C.A.); (V.M.); (R.S.-P.)
- Gastroenterology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- Colorectal Cancer Research Group, ONCOBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
| | - Núria Milà
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.V.); (C.V.)
- Early Detection of Cancer Research Group, EPIBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Núria Vives
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.V.); (C.V.)
- Early Detection of Cancer Research Group, EPIBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carmen Vidal
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.V.); (C.V.)
- Early Detection of Cancer Research Group, EPIBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Gemma Binefa
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.V.); (C.V.)
- Early Detection of Cancer Research Group, EPIBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Judith Rocamora
- Oncology Data Analytics Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (G.I.-S.); (J.R.); (C.A.); (V.M.); (R.S.-P.)
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
| | - Carmen Atencia
- Oncology Data Analytics Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (G.I.-S.); (J.R.); (C.A.); (V.M.); (R.S.-P.)
| | - Víctor Moreno
- Oncology Data Analytics Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (G.I.-S.); (J.R.); (C.A.); (V.M.); (R.S.-P.)
- Colorectal Cancer Research Group, ONCOBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
| | - Rebeca Sanz-Pamplona
- Oncology Data Analytics Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (G.I.-S.); (J.R.); (C.A.); (V.M.); (R.S.-P.)
- Colorectal Cancer Research Group, ONCOBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
| | - Montse Garcia
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (N.M.); (G.B.)
- Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, 08907 Barcelona, Spain; (N.V.); (C.V.)
- Early Detection of Cancer Research Group, EPIBELL Programme, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-60-71-86
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