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General Bowel Screening

FIT - A Little Goes a Long Way

An entry by Prof. Fraser on the Scottish Cancer Prevention Network (SCPN) blog regarding patient sampling and the possible implications of this on both screening and symptomatic assessment.

Fraser, C. (2019) Scottish Cancer Prevention Network Blog 
A comparative effectiveness trial of two faecal immunochemical tests for haemoglobin (FIT). Assessment of test performance and adherence in a single round of a population-based screening programme for colorectal cancer

Randomised controlled trial (ISRCTN20086618) within a population-based colorectal cancer (CRC) screening programme. Subjects eligible for invitation in the Umbria Region (Italy) programme were randomised (ratio 1:1) to be screened using one of the FIT systems. Our results suggest that acceptability and diagnostic performance of HM-JACKarc and of OC-Sensor systems are similar in a screening setting.

Passamonti., et .al (2018) Gut. Vol. 67, no. 3, pp. 485-496 
Is Overdiagnosis a concern for bowel cancer screening in England? – An Analysis of recent trends in colorectal cancer incidence

At this point we could find no evidence of overdiagnosis of CRC. While there has been a 13% increase in CRC incidence in the 60-64 age band, consistent with the first (prevalent) screening round there has been no sustained increase in the older age bands offered screening. Of note there has been an increase in incidence of rectal cancer in women under age 60.

Morling JR, Chapman CJ, Logan RF. (2018) Poster presented at 2018 British Society of Gastroenterology Meeting, Liverpool  
Occult blood in faeces: a window into health beyond the colorectum?

Occult blood in faeces may be telling us about health beyond the colorectum. However, it seems likely that what it tells us about non-CRC risk might be gleaned also from other pieces of information about a patient. Future research avenues, including those proposed by Libby et al,1 will help clarify the implications of the current study. For now, I believe that our enthusiasm for the established CRC screening methods should not be affected, and that the focus after an abnormal faecal occult blood test should be to ensure prompt delivery of a follow-up colonoscopy.

Ladabaum 2018 Gut  
Population-based colorectal cancer screening programmes using a faecal immunochemical test: should faecal haemoglobin cut-offs differ by age and sex?

This study provides detailed outcomes in men and women of different ages at a range of f-Hb cut-offs. We found differences in positivity rates, neoplasia detection rate, number needed to screen, and interval cancers in men and women and in younger and older groups. However, there are factors other than sex and age to consider when consideration is given to setting the f-Hb cut-off.

Arana-Arri et al. 2017 BMC Cancer 
Advances in Fecal Tests for Colorectal Cancer Screening

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. […]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.

Schreuders et al. 2016 Current Treatment Options in Gastroenterology 
The risks of screening: data from the Nottingham randomised controlled trial of faecal occult blood screening for colorectal cancer

There was investigation related morbidity but no mortality and little to support overdiagnosis bias. The group returning falsely negative tests had a better outcome compared with the whole control group. There is a negative side to any screening programme but mortality reduction in this and other trials suggests that a national programme of colorectal cancer screening should be given consideration.

Robinson et al. 1999 GUT 
Sex differences in faecal occult blood test screening for colorectal cancer

Biennial FOBT screening seems to be effective in terms of improving several different outcomes in men, but not in women. Differences in incidence, symptoms and tumour location may explain the differences in screening efficacy between sexes.

Koskenvuo, L. et al (2018) British Journal of Surgery. doi:10.1002/bjs.11011