We conducted a comprehensive search of several electronic databases, including MEDLINE via PubMed, EMBASE via Ovid, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, and the Cochrane Library, without imposing any date or language restrictions. Data extraction and quality assessment were conducted in duplicate. Dominitz N Engl J Med 1999;341:38-46 addresses some questions you might have if you turned out to have a positive test. Not a virtual colonoscopy, or another stool test, or another scan of some sortyou need a real optical colonoscopy. CR, Accessibility Statement, Our website uses cookies to enhance your experience. Terhaar sive Droste The Journal of Applied Laboratory Medicine, A Global Strategy to Eliminate Cervical Cancer, A New Model for Personalized Reference Intervals, How Fit Is FIT for Detecting Colorectal Cancer, How Underspecification Undermines Artificial Intelligence, The Sprint Toward a Better SARS CoV 2 Diagnostics Data System, Commission on Accreditation in Clinical Chemistry. EM, The use of FIT in symptomatic patients is associated with a better prognosis in CRC. In 3 relevant studies, sensitivity for CRC varied from 67% to 100% and specificity from 83% to 95%. et al. Many successful colorectal cancer screening programs, including those in the United States, use some combination of stool-based tests, such as FIT, and screening colonoscopy, Dr. Corley said, so the new study results are very relevant to settings in the United States.. We included 12 studies (6204 participants). Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. But the program in northeast Italy, which started in 2002, has maintained colonoscopy rates of 80% at just 3 months after a positive test result, they noted. In Italy, unlike in the United States, all citizens are entitled to care that is mostly free through Italys National Health Service. The greatest risk for bias occurred owing to flow and timing. Most of these were at high or unclear risk of bias due to suboptimal study design.26,28,30,32,34,36,37 Only 3 studies had a mixed population with personal or familial history of CRC,29,31,35 and 2 studies presented results separately based on the patient history.31,35 A post hoc analysis of studies in individuals with family history of CRC using quantitative FIT resulted in similar summary estimates with the main analysis. eFigure 2. This means that when the test came out positive, there actually was an abnormality 90 percent of the time with Cologuard and 95 percent of the time with FIT. The diagnostic odds ratio (DOR) for diagnosis of CRC and AN was 129 (95% CI, 11-1579) and 11 (95% CI, 8-17), respectively. Higgins Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Also, there are no diet or drug restrictions. Most of these were at high or unclear risk of bias due to suboptimal study design. LA, Accuracy of immunochemical faecal occult blood test for colorectal cancer: meta-analysis [article in Chinese]. The FIT test, or fecal immunochemical blood test, is a newer and more accurate way to test for blood in stool, which can be a symptom of colon cancer. This review was based on a prespecified protocol registered with PROSPERO 2016 (CRD42016037924) and is reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.12. 1 Between 2015 and 2017, there were around 16,300 CRC deaths in the UK every year, equivalent to 45 deaths every day. The Bayesian estimate from the positive test result is almost seven times the assumed 0.7% prevalence. L, However, 14 percent of tests deliver false positive resultsfar higher than the FIT test. and P.P.) This is especially important for those who are averse to colonoscopy. Diagnostic studies evaluating the accuracy of FIT for CRC or AN in patients with a personal or familial history of CRC using colonoscopy as the reference standard. et al; Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. So, in 10 percent of cases using . Tests and investigations for colorectal cancer screening. RA, Davenport Quintero We fitted hierarchical logistic regression models when 4 or more studies were available.21-24. S, ed. We included 12 studies (6204 participants). One . Given the safety, simplicity, low cost, and minimal discomfort of FIT, it is a viable alternative screening strategy for patients at increased risk for CRC. Cost. A positive test result means that 20 micrograms or more of haemoglobin (a protein found in red blood cells) per gram of poo was . Katsoula A, Paschos P, Haidich A, Tsapas A, Giouleme O. All Rights Reserved. Further, she also stated that 9 out of 10 patients who have a positive FIT test DO NOT have cancer. Cloud VA Health Care System would be predicted to reduce the reflex to colonoscopy, based only on . Of the 432 participants who had a positive fecal immunochemical test, 285 underwent a colonoscopy (235 participants showed no polyps or cancer, 47 had polyps identified, and three had colorectal cancer identified). How often does cologuard give a false negative? Robertson // Privacy Policy| After deduplication, we screened 2154 titles and abstracts and rejected 1952 records as noneligible. The PPV was 5.0% to 18.7% in the trials using nonrehydrated slides (Funen and Nottingham studies), and it was 0.9% to 6.1% in the trials using rehydrated slides (Goteborg and Minnesota studies). et al. Given the safety, simplicity, low cost, and minimal discomfort of FIT, it is a viable alternative screening strategy for patients at increased risk for CRC. Fecal immunochemical test (FIT) No direct risk to the colon. FIT is one of the most widely used colorectal cancer screening tests worldwide. Washington, DC 20001 moderator 3rd September 2020. Several limitations have to be acknowledged about the evidence and the review itself. Subgroup analyses indicated that FIT cutoff values between 15- and 25-g/g feces provided the best combination of sensitivity and specificity for the diagnosis of CRC (93% and 94%, respectively). A search of MEDLINE, EMBASE, the Cochrane Library, and gray literature sources identified 3026 records. Colonoscopy is a good test for finding polyps or cancer in the bowel. Subgroup analyses for quantitative FIT and 1-sample FIT showed consistent findings supporting their accuracy; however, we could not draw any conclusions about the diagnostic accuracy of qualitative FIT or use of multiple samples due to insufficient evidence. Surveillance after polypectomy and after resection of colorectal cancer. Drafting of the manuscript: Katsoula, Paschos, Tsapas. FIT is currently FDA-approved for spontaneous stool and DRE, however, samples are not commonly obtained by DRE. Colorectal cancer (CRC) is the third most common type of cancer in men and the second most common in women worldwide. independently extracted data from each included study, using Systematic Review Data Repository.13 For studies presenting results for multiple FIT thresholds, we extracted all data to maximize the yield of information. DC, Curry JA, Eisen Several recently published guidelines support the use of FIT for screening of average-risk participants.44,45 The Canadian Task Force on Preventive Health Care excludes colonoscopy as a primary screening test and recommends screening only with FIT, guaiacbased fecal occult blood tests, or flexible sigmoidoscopy.46 Our results are in line with these suggestions and support use of FIT for screening of increased-risk individuals. We assessed the quality of the evidence in our main analysis but also separately for patients with family history or personal history of CRC. It has recently been suggested that fecal immunochemical testing (FIT) could be used for population-based screening owing to its high accuracy and adherence.7-9 Previous systematic reviews and meta-analyses have assessed the performance of FIT in average-risk populations.10,11 However, the potential role of FIT for screening of individuals at increased risk for CRC has not yet been fully elucidated. After deduplication, 2154 titles and abstracts were screened and 1952 records were rejected or deemed ineligible. Quantitative and 1-sample FIT showed adequate test performance, but data on other FIT brands and multiple samples were insufficient. The methodological quality assessment of the included studies is summarized in eFigures 2 and 3 in the Supplement. On average, the review found that FITs catch about 79 percent of colon cancers, and their specificity consistently tops 90 percent . Findings come from a study that is part of a larger effort to address screening disparities. In June, the U.S. Preventive Services Task . Whiting By continuing to use our site, or clicking "Continue," you are agreeing to our, Figure 2. Finally, the effects on quality of life, morbidity, mortality and overall cost-effectiveness need to be clarified in future studies.49-51. Finally, we evaluated the clinical utility of FIT utilizing Fagan nomograms to depict posttest probability in patients at increased risk for CRC and AN. That . FIT only detects human blood from the lower intestines. As patients with an abnormal result are at greater risk for precancerous polyps or cancer, it is important to attend to follow-up procedures. AACC.org D, Liberati Who should be screened for colon cancer? P. metandi: meta-analysis of diagnostic accuracy using hierarchical logistic regression. Results Gimeno-Garcia P, Hazazi If you get a positive Cologuard result, it means the test detected signs of colon cancer or precancerous polyps. We assessed quality using a meticulous, recently developed tool (QUADAS-2). et al. Results were at least as good as from previous systematic reviews focusing n average-risk individuals.10,11,38 To ensure internal validity of our conclusions, we implemented current guidelines for the conduct and reporting of systematic reviews12,39 and used a prespecified protocol. It looks for tiny traces of blood that you might not be able to see and which could be a sign of cancer. Schnemann H, Brozek J, Guyatt G, Oxman A, ed; GRADE Working Group. All Rights Reserved. A positive FIT test is concerning. Diagnostic accuracy of faecal immunochemical test for screening individuals with a family history of colorectal cancer. E, Nicols-Prez The new faecal immunochemical test (FIT) is due to be introduced into the bowel cancer screening programme (BCSP) in England later this year to replace the current test. Serum sCD26 for colorectal cancer screening in family-risk individuals: comparison with faecal immunochemical test. The average sensitivity of FIT for CRC was 93% (95% CI, 53%-99%), and the average specificity was 91% (95% CI, 89%-92%), yielding a positive likelihood ratio (LR+) of 10.30 (CI 7.7-13.9) and a negative likelihood ratio (LR) of 0.08 (95% CI, 0.01-0.75) (GRADE: very low). These data support the annual use of FIT in individuals at increased risk for CRC as an alternative screening strategy for patients who refuse to use colonoscopy. DJ, Lee Bariatric Surgery May Reduce Risk of Common Cancers, U.S. Department of Health and Human Services. Our results suggest that given FIT safety, simplicity, low cost, and low discomfort, it could be used as an acceptable alternative for screening of individuals at increased risk for CRC.
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