SNFGE SNFGE
 
Thématique :
- Cancer colorectal (CCR)
Originalité :
Intermédiaire
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Thomas APARICIO
Coup de coeur :
 
 
Gut
  2016/04  
 
  2016 Mar 22. pii: gutjnl-2015-310102  
  doi: 10.1136/gutjnl-2015-310102  
 
  Immunochemical faecal occult blood testing to screen for colorectal cancer: can the screening interval be extended?  
 
  Haug U, Grobbee EJ, Lansdorp-Vogelaar I, Spaander MC, Kuipers EJ  
  http://www.ncbi.nlm.nih.gov/pubmed/27006184  
 
 

OBJECTIVE:

Colorectal cancer (CRC) screening programmes based on faecal immunochemical testing for haemoglobin (FIT) typically use a screening interval of 2 years. We aimed to estimate how alternative FIT strategies that use a lower than usual positivity threshold followed by a longer screening interval compare with conventional strategies.

METHODS:

We analysed longitudinal data of 4523 Dutch individuals (50-74 years at baseline) participating in round I of a one-sample FIT screening programme, of which 3427 individuals also participated in round II after 1-3 years. The cohort was followed until 2 years after round II. In both rounds, a cut-off level of ≥50 ng haemoglobin (Hb)/mL buffer (corresponding to 10 µg Hb/g faeces) was used, representing the standard scenario. We determined the cumulative positivity rate (PR) and the numbers of subjects diagnosed with advanced adenomas (N_AdvAd) and early stage CRC (N_earlyCRC) in the cohort over two rounds of screening (standard scenario) and compared it with hypothetical single-round screening with use of a lower cut-off and omission of the second round (alternative scenario).

RESULTS:

In the standard scenario, the cumulative (ie, round I and II combined) PR, N_AdvAd and N_earlyCRC were 13%, 180% and 26%, respectively. In alternative scenarios using a cut-off level of respectively ≥11 and ≥22 ng Hb/mL buffer (corresponding to 2 and 4 µg Hb/g faeces), the PRs were 18% and 13%, the N_AdvAd were 180 and 162 and the N_earlyCRC ranged between 22-27 and 22-26.

CONCLUSIONS:

The diagnostic yield of FIT screening using a lowered positivity threshold in combination with an extended screening interval (up to 5 years) may be similar to conventional FIT strategies. This justifies and motivates further research steps in this direction.

 
Question posée
 
Peut-on élargir l’intervalle entre les tests FIT en diminuant le seuil de détection de l’Hb ?
 
Question posée
 
Oui
 
Commentaires

Ces résultats préliminaires issuent d’une modélisation doivent être confirmés. Le nombre de colonoscopie cumulé augmente si le seuil est choisi à 11 ng Hb/ml de tampon mais pas si il est choisi à 22 ng d’Hb.

 
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