More time between fecal colorectal cancer tests seems viable

Last Updated: 2016-04-07

By David Douglas

NEW YORK (Reuters Health) - Extending the colorectal cancer (CRC) screening interval for fecal immunochemical testing for hemoglobin (FIT), from about two to five years may be possible, according to estimates from European researchers.

As Dr. Ulrike Haug told Reuters Health by email, "Our study suggests that stool-based colorectal cancer screening could be simplified and thus improved. With a longer interval, only about half of tests are to be done. In the long run, this makes it easier for the participant to meet the requirements of the program and to benefit from it most."

In a March 22 online paper in Gut, Dr. Haug, of the Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany, and colleagues noted that to examine such a strategy they analyzed data on more than 4,500 participants in round one of a FIT screening program. More than 3,400 went on to a second round after one to three years.

The cohort was followed until two years after round two. In both rounds, a cut-off level corresponding to 10 mcg of Hb/g of feces was used as the standard scenario.

Under these conditions, the cumulative positivity rate (PR) was 13%, the number of patients with advanced adenoma was 180 and for early stage CRC, it was 26.

The researchers then assumed use of a lower cut-off level in the first round and omission of the second round, resulting in an extended screening interval.

With a cutoff point of 2 mcg of Hb/g of feces, the PR rate was 18%, advanced adenoma was seen in 180 and early stage CRC in 22 to 27 patients. With a 4 mcg cutoff point, the corresponding numbers were 13%, 162, and 22 to 26.

Thus, the diagnostic yield was similar to standard FIT screening but due to the longer interval the number of FITs was halved. And added Dr. Haug, "The efforts and costs related to the organization of a screening program are reduced."

The researchers concede shortcomings in the approach, but call for further studies given "that such alternative strategies could present interesting options for CRC screening, either generally or in particular settings."

Commenting on the findings by email, gastroenterologist Dr. Peter S. Liang told Reuters Health, "One of the biggest challenges of FIT screening is making sure people get repeat testing on a regular basis."

Dr. Liang of New York University School of Medicine and the Veterans Affairs New York Harbor Healthcare System, added, "This study shows that lowering the positivity cutoff and extending FIT screening up to every five years may be just as good as screening biannually with a higher cutoff, which may make it more acceptable to patients and less costly for health care systems."

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1TCjfN7

Gut 2016.