Influence of varying quantitative fecal immunochemical test positivity thresholds on colorectal cancer detection: A community-based cohort study

Kevin Selby, Christopher D. Jensen, Jeffrey K. Lee, Chyke A. Doubeni, Joanne E. Schottinger, Wei K. Zhao, Jessica Chubak, Ethan Halm, Nirupa R. Ghai, Richard Contreras, Celette Skinner, Aruna Kamineni, Theodore R. Levin, Douglas A. Corley

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: The fecal immunochemical test (FIT) is commonly used for colorectal cancer (CRC) screening. Despite demographic variations in stool hemoglobin concentrations, few data exist regarding optimal positivity thresholds by age and sex. Objective: To identify programmatic (multitest) FIT performance characteristics and optimal FIT quantitative hemoglobin positivity thresholds in a large, population-based, screening program. Design: Retrospective cohort study. Setting: Kaiser Permanente Northern and Southern California. Participants: Adults aged 50 to 75 years who were eligible for screening and had baseline quantitative FIT results (2013 to 2014) and 2 years of follow-up. Nearly two thirds (411 241) had FIT screening in the previous 2 years. Measurements: FIT programmatic sensitivity for CRC and number of positive test results per cancer case detected, overall and by age and sex. Results: Of 640 859 persons who completed a baseline FIT and were followed for 2 years, 481 817 (75%) had at least 1 additional FIT and 1245 (0.19%) received a CRC diagnosis. Cancer detection (programmatic sensitivity) increased at lower positivity thresholds, from 822 in 1245 (66.0%) at 30 μg/g to 925 (74.3%) at 20 μg/g and 987 (79.3%) at 10 μg/g; the number of positive test results per cancer case detected increased from 43 at 30 μg/g to 52 at 20 μg/g and 85 at 10 μg/g. Reducing the positivity threshold from 20 to 15 μg/g would detect 3% more cancer cases and require 23% more colonoscopies. At the conventional FIT threshold of 20 μg/g, programmatic sensitivity decreased with increasing age (79.0%, 73.4%, and 68.9% for ages 50 to 59, 60 to 69, and 70 to 75 years, respectively; P = 0.009) and was higher in men than women (77.0% vs. 70.6%; P = 0.011). Limitation: Information on advanced adenoma was lacking. Conclusion: Increased cancer detection at lower positivity thresholds is counterbalanced by substantial increases in positive tests. Tailored thresholds may provide screening benefits that are more equal among different demographic groups, depending on local resources.

Original languageEnglish (US)
Pages (from-to)439-447
Number of pages9
JournalAnnals of Internal Medicine
Volume169
Issue number7
DOIs
StatePublished - Oct 2 2018

Fingerprint

Colorectal Neoplasms
Cohort Studies
Neoplasms
Hemoglobins
Demography
Colonoscopy
Early Detection of Cancer
Adenoma
Retrospective Studies
Population

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Influence of varying quantitative fecal immunochemical test positivity thresholds on colorectal cancer detection : A community-based cohort study. / Selby, Kevin; Jensen, Christopher D.; Lee, Jeffrey K.; Doubeni, Chyke A.; Schottinger, Joanne E.; Zhao, Wei K.; Chubak, Jessica; Halm, Ethan; Ghai, Nirupa R.; Contreras, Richard; Skinner, Celette; Kamineni, Aruna; Levin, Theodore R.; Corley, Douglas A.

In: Annals of Internal Medicine, Vol. 169, No. 7, 02.10.2018, p. 439-447.

Research output: Contribution to journalArticle

Selby, K, Jensen, CD, Lee, JK, Doubeni, CA, Schottinger, JE, Zhao, WK, Chubak, J, Halm, E, Ghai, NR, Contreras, R, Skinner, C, Kamineni, A, Levin, TR & Corley, DA 2018, 'Influence of varying quantitative fecal immunochemical test positivity thresholds on colorectal cancer detection: A community-based cohort study', Annals of Internal Medicine, vol. 169, no. 7, pp. 439-447. https://doi.org/10.7326/M18-0244
Selby, Kevin ; Jensen, Christopher D. ; Lee, Jeffrey K. ; Doubeni, Chyke A. ; Schottinger, Joanne E. ; Zhao, Wei K. ; Chubak, Jessica ; Halm, Ethan ; Ghai, Nirupa R. ; Contreras, Richard ; Skinner, Celette ; Kamineni, Aruna ; Levin, Theodore R. ; Corley, Douglas A. / Influence of varying quantitative fecal immunochemical test positivity thresholds on colorectal cancer detection : A community-based cohort study. In: Annals of Internal Medicine. 2018 ; Vol. 169, No. 7. pp. 439-447.
@article{af25fb974c584515b63079fd1959d346,
title = "Influence of varying quantitative fecal immunochemical test positivity thresholds on colorectal cancer detection: A community-based cohort study",
abstract = "Background: The fecal immunochemical test (FIT) is commonly used for colorectal cancer (CRC) screening. Despite demographic variations in stool hemoglobin concentrations, few data exist regarding optimal positivity thresholds by age and sex. Objective: To identify programmatic (multitest) FIT performance characteristics and optimal FIT quantitative hemoglobin positivity thresholds in a large, population-based, screening program. Design: Retrospective cohort study. Setting: Kaiser Permanente Northern and Southern California. Participants: Adults aged 50 to 75 years who were eligible for screening and had baseline quantitative FIT results (2013 to 2014) and 2 years of follow-up. Nearly two thirds (411 241) had FIT screening in the previous 2 years. Measurements: FIT programmatic sensitivity for CRC and number of positive test results per cancer case detected, overall and by age and sex. Results: Of 640 859 persons who completed a baseline FIT and were followed for 2 years, 481 817 (75{\%}) had at least 1 additional FIT and 1245 (0.19{\%}) received a CRC diagnosis. Cancer detection (programmatic sensitivity) increased at lower positivity thresholds, from 822 in 1245 (66.0{\%}) at 30 μg/g to 925 (74.3{\%}) at 20 μg/g and 987 (79.3{\%}) at 10 μg/g; the number of positive test results per cancer case detected increased from 43 at 30 μg/g to 52 at 20 μg/g and 85 at 10 μg/g. Reducing the positivity threshold from 20 to 15 μg/g would detect 3{\%} more cancer cases and require 23{\%} more colonoscopies. At the conventional FIT threshold of 20 μg/g, programmatic sensitivity decreased with increasing age (79.0{\%}, 73.4{\%}, and 68.9{\%} for ages 50 to 59, 60 to 69, and 70 to 75 years, respectively; P = 0.009) and was higher in men than women (77.0{\%} vs. 70.6{\%}; P = 0.011). Limitation: Information on advanced adenoma was lacking. Conclusion: Increased cancer detection at lower positivity thresholds is counterbalanced by substantial increases in positive tests. Tailored thresholds may provide screening benefits that are more equal among different demographic groups, depending on local resources.",
author = "Kevin Selby and Jensen, {Christopher D.} and Lee, {Jeffrey K.} and Doubeni, {Chyke A.} and Schottinger, {Joanne E.} and Zhao, {Wei K.} and Jessica Chubak and Ethan Halm and Ghai, {Nirupa R.} and Richard Contreras and Celette Skinner and Aruna Kamineni and Levin, {Theodore R.} and Corley, {Douglas A.}",
year = "2018",
month = "10",
day = "2",
doi = "10.7326/M18-0244",
language = "English (US)",
volume = "169",
pages = "439--447",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "7",

}

TY - JOUR

T1 - Influence of varying quantitative fecal immunochemical test positivity thresholds on colorectal cancer detection

T2 - A community-based cohort study

AU - Selby, Kevin

AU - Jensen, Christopher D.

AU - Lee, Jeffrey K.

AU - Doubeni, Chyke A.

AU - Schottinger, Joanne E.

AU - Zhao, Wei K.

AU - Chubak, Jessica

AU - Halm, Ethan

AU - Ghai, Nirupa R.

AU - Contreras, Richard

AU - Skinner, Celette

AU - Kamineni, Aruna

AU - Levin, Theodore R.

AU - Corley, Douglas A.

PY - 2018/10/2

Y1 - 2018/10/2

N2 - Background: The fecal immunochemical test (FIT) is commonly used for colorectal cancer (CRC) screening. Despite demographic variations in stool hemoglobin concentrations, few data exist regarding optimal positivity thresholds by age and sex. Objective: To identify programmatic (multitest) FIT performance characteristics and optimal FIT quantitative hemoglobin positivity thresholds in a large, population-based, screening program. Design: Retrospective cohort study. Setting: Kaiser Permanente Northern and Southern California. Participants: Adults aged 50 to 75 years who were eligible for screening and had baseline quantitative FIT results (2013 to 2014) and 2 years of follow-up. Nearly two thirds (411 241) had FIT screening in the previous 2 years. Measurements: FIT programmatic sensitivity for CRC and number of positive test results per cancer case detected, overall and by age and sex. Results: Of 640 859 persons who completed a baseline FIT and were followed for 2 years, 481 817 (75%) had at least 1 additional FIT and 1245 (0.19%) received a CRC diagnosis. Cancer detection (programmatic sensitivity) increased at lower positivity thresholds, from 822 in 1245 (66.0%) at 30 μg/g to 925 (74.3%) at 20 μg/g and 987 (79.3%) at 10 μg/g; the number of positive test results per cancer case detected increased from 43 at 30 μg/g to 52 at 20 μg/g and 85 at 10 μg/g. Reducing the positivity threshold from 20 to 15 μg/g would detect 3% more cancer cases and require 23% more colonoscopies. At the conventional FIT threshold of 20 μg/g, programmatic sensitivity decreased with increasing age (79.0%, 73.4%, and 68.9% for ages 50 to 59, 60 to 69, and 70 to 75 years, respectively; P = 0.009) and was higher in men than women (77.0% vs. 70.6%; P = 0.011). Limitation: Information on advanced adenoma was lacking. Conclusion: Increased cancer detection at lower positivity thresholds is counterbalanced by substantial increases in positive tests. Tailored thresholds may provide screening benefits that are more equal among different demographic groups, depending on local resources.

AB - Background: The fecal immunochemical test (FIT) is commonly used for colorectal cancer (CRC) screening. Despite demographic variations in stool hemoglobin concentrations, few data exist regarding optimal positivity thresholds by age and sex. Objective: To identify programmatic (multitest) FIT performance characteristics and optimal FIT quantitative hemoglobin positivity thresholds in a large, population-based, screening program. Design: Retrospective cohort study. Setting: Kaiser Permanente Northern and Southern California. Participants: Adults aged 50 to 75 years who were eligible for screening and had baseline quantitative FIT results (2013 to 2014) and 2 years of follow-up. Nearly two thirds (411 241) had FIT screening in the previous 2 years. Measurements: FIT programmatic sensitivity for CRC and number of positive test results per cancer case detected, overall and by age and sex. Results: Of 640 859 persons who completed a baseline FIT and were followed for 2 years, 481 817 (75%) had at least 1 additional FIT and 1245 (0.19%) received a CRC diagnosis. Cancer detection (programmatic sensitivity) increased at lower positivity thresholds, from 822 in 1245 (66.0%) at 30 μg/g to 925 (74.3%) at 20 μg/g and 987 (79.3%) at 10 μg/g; the number of positive test results per cancer case detected increased from 43 at 30 μg/g to 52 at 20 μg/g and 85 at 10 μg/g. Reducing the positivity threshold from 20 to 15 μg/g would detect 3% more cancer cases and require 23% more colonoscopies. At the conventional FIT threshold of 20 μg/g, programmatic sensitivity decreased with increasing age (79.0%, 73.4%, and 68.9% for ages 50 to 59, 60 to 69, and 70 to 75 years, respectively; P = 0.009) and was higher in men than women (77.0% vs. 70.6%; P = 0.011). Limitation: Information on advanced adenoma was lacking. Conclusion: Increased cancer detection at lower positivity thresholds is counterbalanced by substantial increases in positive tests. Tailored thresholds may provide screening benefits that are more equal among different demographic groups, depending on local resources.

UR - http://www.scopus.com/inward/record.url?scp=85054230150&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054230150&partnerID=8YFLogxK

U2 - 10.7326/M18-0244

DO - 10.7326/M18-0244

M3 - Article

C2 - 30242328

AN - SCOPUS:85054230150

VL - 169

SP - 439

EP - 447

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 7

ER -