Annual Self-Screening With FIT Effective for Colorectal Cancer Detection
FIT Follow-Up Varies There is significant variation in the time between patient’s receipt of positive fecal blood test results and the follow-up colonoscopies, according to a study published Feb. 4 in Cancer Epidemiology, Biomarkers and Prevention. While health care system factors influence the length of this lag, laboratories may able to help improve processes involving return of abnormal test results. Using data from the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium, researchers identified 62,384 individuals (aged 50 to 89 years) with a positive fecal blood test (fecal occult blood tests or fecal immunochemical tests) between 2011 and 2012 in four U.S. health care systems. The researchers found that most patients who received a colonoscopy did so within 6 months of their positive fecal blood test result, although follow-up rates varied significantly across health care systems (median range, 41 to 174 days, while the percent followed-up by 12 months ranged from 58.1 percent to 83.8 percent). Increasing age and comorbidities were associated with lower follow-up rates, but health system differences persisted at 1, 2, 3, and 6 months. "Data support the importance of organizational factors in the completion of diagnostic work-up of positive fecal blood tests," write the authors […]
FIT Follow-Up Varies Using data from the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium, researchers identified 62,384 individuals (aged 50 to 89 years) with a positive fecal blood test (fecal occult blood tests or fecal immunochemical tests) between 2011 and 2012 in four U.S. health care systems. The researchers found that most patients who received a colonoscopy did so within 6 months of their positive fecal blood test result, although follow-up rates varied significantly across health care systems (median range, 41 to 174 days, while the percent followed-up by 12 months ranged from 58.1 percent to 83.8 percent). Increasing age and comorbidities were associated with lower follow-up rates, but health system differences persisted at 1, 2, 3, and 6 months. "Data support the importance of organizational factors in the completion of diagnostic work-up of positive fecal blood tests," write the authors led by Jessica Chubak, from the Group Health Research Institute in Seattle, Wash. "There is increasing interest in studying follow-up to abnormal screening tests in a multilevel context…. Such studies are needed to lay the groundwork for future research on improving the effectiveness of cancer screening." |
Annual, programmatic fecal immunochemical test (FIT) screening for colorectal cancer (CRC) is both feasible and effective in a large community-based setting, according to a study published Jan. 26 in the Annals of Internal Medicine. Annual FIT screening has high sensitivity for CRC and maintains high adherence to annual follow-up screening among initial participants.
Annual, high sensitivity fecal occult blood tests are believed to be as effective as colonoscopy screening every 10 years, if levels of adherence are high, the authors say. In addition to being noninvasive and deliverable by mail, FIT screening can be performed without dietary or medication restrictions, giving it higher patient acceptance. Despite its promise to boost CRC screening adherence, most research to date, the authors say, evaluated FIT test performance in the first round, not how it does in later rounds of repeat testing.
In the present study, researchers identified 323,349 Kaiser Permanente Northern California and Southern California health plan members (aged 50 to 70 years) on the FIT mailing list (in 2007 or 2008), who completed the first round of FIT. Patients were followed for up to 4 screening rounds.
The researchers found that of the patients invited for screening, 48.2 percent participated in the first round. Of those who remained eligible, 75.3 percent to 86.1 percent of round one participants also took part in subsequent rounds. Across all screening rounds, 63.8 percent of distributed tests were completed within one year of mailing. Over the four screening rounds, 7 percent of patients crossed over to endoscopy because of a positive FIT test.
Round one had the highest FIT positivity rate (5.0 percent) and positive predictive values (adenoma, 51.5 percent; CRC, 3.4 percent). These lower, but relatively stable measures in subsequent rounds, likely reflect prevalent cancers initially and incident cancers subsequently. Following this same pattern of prevalence cancer, the FIT sensitivity for CRC was highest (84.5 percent) in the first screening round and declined to a more steady state (range in sensitivity, 73.4 percent to 78.0 percent) in subsequent rounds of screening.
Takeaway: Patients who initiate FIT screening for CRC are highly likely to adhere to an annual screening schedule. Furthermore, repeated FIT testing has a high sensitivity to detect CRC in a large community cohort.
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