Abstract
Background and Aims: Most colorectal cancer (CRC) screening programs based on the fecal immunochemical test (FIT) use the same cutoff value for all participants. This study aimed at finding age- and gender-specific cutoff values that can improve population-based CRC screening. Methods: This observational study used data from the first 2 years of the Danish FIT-based CRC screening program to estimate sensitivity, specificity, number of positive tests, number of screen-detected cancers and adenomas, and number of interval cancers for various cutoff values for different male and female age groups. Results: Data from 531,828 participants showed that lower cutoff values for older residents and higher cutoff values for younger residents increased the overall sensitivity and specificity, decreased the number of needed colonoscopies by 7%, increased the number of screen-detected cancer by 1.1%, increased the number of screen-detected adenomas by 5%, and decreased the number of interval cancers by approximately 1.5%. However, these cutoff values also increased an inequality in sensitivity and specificity. Choosing cutoff values that ensured equal sensitivity between the groups, however, did increase inequality in, for example, the interval cancer rate. Conclusions: In a FIT-based CRC program it is possible to decrease the number of needed colonoscopies while at the same time to increase overall sensitivity and specificity and detect more cancers and adenomas by using different cutoff values for different male and female age groups. However, this increases inequality in sensitivity and specificity, whereas other strategies like ensuring equal sensitivity could be considered.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Gastrointestinal Endoscopy |
| Vol/bind | 95 |
| Udgave nummer | 3 |
| Sider (fra-til) | 540-549 |
| Antal sider | 10 |
| ISSN | 0016-5107 |
| DOI | |
| Status | Udgivet - 2022 |
Bibliografisk note
Funding Information:The Health Research Fund of Central Denmark Region funded the study but had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Data were provided by the Danish CRC screening database. Data that support the findings of this study are available from The Danish Health Data Authority and The Danish Clinical Quality Program-National Clinical Registries (RKKP). Restrictions apply to the availability of these data, which were used under license for this study. Data may be available on reasonable request to The Danish Health Data Authority and The Danish Clinical Quality Program-National Clinical Registries (RKKP). DISCLOSURE: The following author received research support for this study from the Health Research Fund of Central Denmark Region (no. A1518): S. H. Njor. In addition, the following authors disclosed financial relationships: S. H. Njor: Speaker for Norgine. M. Rasmussen: Speaker for Norgine and Ferring Pharmaceuticals. All other authors disclosed no financial relationships.
Funding Information:
DISCLOSURE: The following author received research support for this study from the Health Research Fund of Central Denmark Region (no. A1518): S. H. Njor. In addition, the following authors disclosed financial relationships: S. H. Njor: Speaker for Norgine. M. Rasmussen: Speaker for Norgine and Ferring Pharmaceuticals. All other authors disclosed no financial relationships.
Publisher Copyright:
© 2022 American Society for Gastrointestinal Endoscopy