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CRC rates low after negative FIT regardless of cutoff
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Incidence of interval colorectal cancer after a negative result from a fecal immunochemical test is low, according to data collected from a population-based screening program.
Esther Toes-Zoutendijk, of the department of public health at Erasmus MC University Medical Center in the Netherlands, and colleagues wrote that although FIT has shown to be effective in detecting CRC at low cutoffs or at short screening intervals, programs often use higher cutoffs to find a balance between true and false positives.
To explore the effects of different cutoff values, researchers analyzed data collected from patients who participated in a nationwide CRC screening program in 2014 who had a negative result from first-round FIT screening. After starting out with a cutoff of 15 µg Hb/g feces, the Dutch national program increased the cutoff to 47 µg Hb/g feces, allowing investigators to compare the cumulative incidence of interval cancer after a negative at the different cutoff values.
Of 485,112 individuals with a negative result from FIT, 544 interval cancers were detected, including 126 out of 111,800 individuals in the low cutoff group and 418 in 373,312 individuals in the high cutoff group.
Investigators found that the age-adjusted, 2-year cumulative incidence of interval cancer after a negative result was 9.5 per 10,000 persons in the low cutoff group compared with 13.8 per 10,000 persons in the high cutoff group (P < .005).
Additionally, the age-adjusted sensitivity of FIT for CRC was 90.5% in the low cutoff group compared with 82.9% in the high cutoff group (P < .0001), while the test identified men with CRC with 87.4% sensitivity compared with 82.6% among women (P < .001).
Toes-Zoutendijk and colleagues wrote that their findings show a high overall sensitivity for FIT to detect CRC.
“The incidence of interval CRC after a negative result from FIT is low,” they wrote. “Although FIT sensitivity for declined with a higher cutoff, it remained above 80%.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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