TY - JOUR
T1 - Challenges and approaches to measuring repeat fecal immunochemical test for colorectal cancer screening
AU - Murphy, Caitlin C.
AU - Halm, Ethan A.
AU - Skinner, Celette Sugg
AU - Balasubramanian, Bijal A.
AU - Singal, Amit G.
N1 - Funding Information:
The research reported in this article was supported by the NCI at the NIH under award numbers U54 CA163308 and UM1 CA222035 (to C.S. Skinner, E.A. Halm) and the Cancer Prevention and Research Institute of Texas under award number PP160075 (to A.G. Singal).
Publisher Copyright:
© 2020 American Association for Cancer Research.
PY - 2020/8
Y1 - 2020/8
N2 - Background: Colorectal cancer screening with fecal immunochemical testing (FIT) can reduce colorectal cancer–related mortality. Effectiveness of FIT may be compromised when patients do not adhere to a regular schedule. However, having no standard measure of repeat FIT presents challenges for assessing effectiveness across populations and settings. We compared three measures of repeat FIT in a large, integrated health care system in Dallas, Texas. Methods: We identified 18,257 patients age-eligible (50–60 years) for FIT in January 1–December 31, 2010 and followed over four rounds of screening. Measures included: (i) repeat FIT in prior screeners, or completion of FIT within 9–15 months of the previous; (ii) yes–no patterns, whereby patients were assigned yes or no in 9–15 month windows; and 3) proportion of time covered (PTC), or the amount of time patients were up-to-date with screening relative to time eligible. Results: Repeat FIT varied by measure. Using a prior screeners measure, 15.8% of patients with a normal FIT in round 1 completed repeat FIT in round 2. Repeat FIT was notably higher (52.3%) using PTC. The most common yes–no pattern was YNNN or “one-and-done,” and only 9.4% of patients completed two consecutive FITs across all rounds (YYNN). Conclusions: Different measures of repeat FIT yielded a range of estimates, making comparison across studies difficult. Researchers should weigh the advantages and disadvantages of each measure and select the most appropriate to their research question. Impact: Our study highlights the need for future research of repeat FIT measures that best approximate screening effectiveness.
AB - Background: Colorectal cancer screening with fecal immunochemical testing (FIT) can reduce colorectal cancer–related mortality. Effectiveness of FIT may be compromised when patients do not adhere to a regular schedule. However, having no standard measure of repeat FIT presents challenges for assessing effectiveness across populations and settings. We compared three measures of repeat FIT in a large, integrated health care system in Dallas, Texas. Methods: We identified 18,257 patients age-eligible (50–60 years) for FIT in January 1–December 31, 2010 and followed over four rounds of screening. Measures included: (i) repeat FIT in prior screeners, or completion of FIT within 9–15 months of the previous; (ii) yes–no patterns, whereby patients were assigned yes or no in 9–15 month windows; and 3) proportion of time covered (PTC), or the amount of time patients were up-to-date with screening relative to time eligible. Results: Repeat FIT varied by measure. Using a prior screeners measure, 15.8% of patients with a normal FIT in round 1 completed repeat FIT in round 2. Repeat FIT was notably higher (52.3%) using PTC. The most common yes–no pattern was YNNN or “one-and-done,” and only 9.4% of patients completed two consecutive FITs across all rounds (YYNN). Conclusions: Different measures of repeat FIT yielded a range of estimates, making comparison across studies difficult. Researchers should weigh the advantages and disadvantages of each measure and select the most appropriate to their research question. Impact: Our study highlights the need for future research of repeat FIT measures that best approximate screening effectiveness.
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U2 - 10.1158/1055-9965.EPI-20-0230
DO - 10.1158/1055-9965.EPI-20-0230
M3 - Article
C2 - 32457184
AN - SCOPUS:85089126395
SN - 1055-9965
VL - 29
SP - 1557
EP - 1563
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
IS - 8
ER -