Diagnostic accuracy of risk assessment and fecal immunochemical test in colorectal cancer screening: Results from a population‐based program and meta‐analysis
Abstract Background Fecal immunochemical test (FIT) is a commonly used initial test for colorectal cancer (CRC) screening. Parallel use of FIT with risk assessment (RA) could improve the detection of non‐bleeding lesions, but at the expense of compromising sensitivity. In this study, we evaluated th...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-09-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.6399 |
| _version_ | 1797672405965996032 |
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| author | Ziyang Wang Jiaoyue Teng Weimiao Wu Jianming Dou Martin C. S. Wong Yangming Gong Junjie Huang Kai Gu Wanghong Xu |
| author_facet | Ziyang Wang Jiaoyue Teng Weimiao Wu Jianming Dou Martin C. S. Wong Yangming Gong Junjie Huang Kai Gu Wanghong Xu |
| author_sort | Ziyang Wang |
| collection | DOAJ |
| description | Abstract Background Fecal immunochemical test (FIT) is a commonly used initial test for colorectal cancer (CRC) screening. Parallel use of FIT with risk assessment (RA) could improve the detection of non‐bleeding lesions, but at the expense of compromising sensitivity. In this study, we evaluated the accuracy of FIT and/or RA in the Shanghai CRC screening program, and systematically reviewed the relevant evaluations worldwide. Methods RA and 2‐specimen FIT were used in parallel in the Shanghai screening program, followed by a colonoscopy among those with positive results. Sensitivity, specificity, detection rate of CRC, positive predictive value (PPV), and other measures with their 95% confident intervals were calculated for each type of tests and several assumed combined tests. We further searched PubMed, Embase, Web of Science, and Cochrane Library for relevant studies published in English up to January 5, 2022. Results By the end of 2019, a total of 1,901,360 participants of the screening program completed 3,045,108 tests, with 1,901,360 first‐time tests and 1,143,748 subsequent tests. Parallel use of RA and 2‐specimen FIT achieved a sensitivity of 0.78 (0.77–0.80), a specificity of 0.78 (0.78–0.78), PPV of 0.89% (0.86–0.92), and a detection rate of 1.99 (1.93–2.05) for CRC per 1000 among participants enrolled in the first screening round, and performed similarly among those who participated for several times. A meta‐analysis of 103 published observational studies demonstrated a higher sensitivity [0.76 (0.36, 0.94)] but a much lower specificity [0.59 (0.28, 0.85)] of parallel use of RA and FIT for detecting CRC in average‐risk populations than in our subjects. One‐specimen FIT, the most commonly used initial test, had a pooled specificity comparable to the Shanghai screening program (0.92 vs. 0.91), but a much higher pooled sensitivity (0.76 vs. 0.57). Conclusion Our results indicate the limitation of FIT only as an initial screening test for CRC in Chinese populations, and highlight the higher sensitivity of parallel use of RA and FIT. Attempts should be made to optimize RA to improve effectiveness of screening in the populations. |
| first_indexed | 2024-03-11T21:29:34Z |
| format | Article |
| id | doaj.art-1990d402c2aa4273b418668cee9ed24f |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-11T21:29:34Z |
| publishDate | 2023-09-01 |
| publisher | Wiley |
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| series | Cancer Medicine |
| spelling | doaj.art-1990d402c2aa4273b418668cee9ed24f2023-09-27T11:46:08ZengWileyCancer Medicine2045-76342023-09-011217181891820010.1002/cam4.6399Diagnostic accuracy of risk assessment and fecal immunochemical test in colorectal cancer screening: Results from a population‐based program and meta‐analysisZiyang Wang0Jiaoyue Teng1Weimiao Wu2Jianming Dou3Martin C. S. Wong4Yangming Gong5Junjie Huang6Kai Gu7Wanghong Xu8Department of Epidemiology Fudan University School of Public Health Shanghai ChinaDepartment of Epidemiology Fudan University School of Public Health Shanghai ChinaDepartment of Epidemiology Fudan University School of Public Health Shanghai ChinaThe Shanghai Municipal Centers for Disease Control and Prevention Shanghai ChinaJockey Club School of Public Health and Primary Care, Faculty of Medicine The Chinese University of Hong Kong Hong Kong ChinaThe Shanghai Municipal Centers for Disease Control and Prevention Shanghai ChinaJockey Club School of Public Health and Primary Care, Faculty of Medicine The Chinese University of Hong Kong Hong Kong ChinaThe Shanghai Municipal Centers for Disease Control and Prevention Shanghai ChinaDepartment of Epidemiology Fudan University School of Public Health Shanghai ChinaAbstract Background Fecal immunochemical test (FIT) is a commonly used initial test for colorectal cancer (CRC) screening. Parallel use of FIT with risk assessment (RA) could improve the detection of non‐bleeding lesions, but at the expense of compromising sensitivity. In this study, we evaluated the accuracy of FIT and/or RA in the Shanghai CRC screening program, and systematically reviewed the relevant evaluations worldwide. Methods RA and 2‐specimen FIT were used in parallel in the Shanghai screening program, followed by a colonoscopy among those with positive results. Sensitivity, specificity, detection rate of CRC, positive predictive value (PPV), and other measures with their 95% confident intervals were calculated for each type of tests and several assumed combined tests. We further searched PubMed, Embase, Web of Science, and Cochrane Library for relevant studies published in English up to January 5, 2022. Results By the end of 2019, a total of 1,901,360 participants of the screening program completed 3,045,108 tests, with 1,901,360 first‐time tests and 1,143,748 subsequent tests. Parallel use of RA and 2‐specimen FIT achieved a sensitivity of 0.78 (0.77–0.80), a specificity of 0.78 (0.78–0.78), PPV of 0.89% (0.86–0.92), and a detection rate of 1.99 (1.93–2.05) for CRC per 1000 among participants enrolled in the first screening round, and performed similarly among those who participated for several times. A meta‐analysis of 103 published observational studies demonstrated a higher sensitivity [0.76 (0.36, 0.94)] but a much lower specificity [0.59 (0.28, 0.85)] of parallel use of RA and FIT for detecting CRC in average‐risk populations than in our subjects. One‐specimen FIT, the most commonly used initial test, had a pooled specificity comparable to the Shanghai screening program (0.92 vs. 0.91), but a much higher pooled sensitivity (0.76 vs. 0.57). Conclusion Our results indicate the limitation of FIT only as an initial screening test for CRC in Chinese populations, and highlight the higher sensitivity of parallel use of RA and FIT. Attempts should be made to optimize RA to improve effectiveness of screening in the populations.https://doi.org/10.1002/cam4.6399colorectal cancerdiagnostic accuracyfecal immunochemical testrisk assessmentscreening |
| spellingShingle | Ziyang Wang Jiaoyue Teng Weimiao Wu Jianming Dou Martin C. S. Wong Yangming Gong Junjie Huang Kai Gu Wanghong Xu Diagnostic accuracy of risk assessment and fecal immunochemical test in colorectal cancer screening: Results from a population‐based program and meta‐analysis Cancer Medicine colorectal cancer diagnostic accuracy fecal immunochemical test risk assessment screening |
| title | Diagnostic accuracy of risk assessment and fecal immunochemical test in colorectal cancer screening: Results from a population‐based program and meta‐analysis |
| title_full | Diagnostic accuracy of risk assessment and fecal immunochemical test in colorectal cancer screening: Results from a population‐based program and meta‐analysis |
| title_fullStr | Diagnostic accuracy of risk assessment and fecal immunochemical test in colorectal cancer screening: Results from a population‐based program and meta‐analysis |
| title_full_unstemmed | Diagnostic accuracy of risk assessment and fecal immunochemical test in colorectal cancer screening: Results from a population‐based program and meta‐analysis |
| title_short | Diagnostic accuracy of risk assessment and fecal immunochemical test in colorectal cancer screening: Results from a population‐based program and meta‐analysis |
| title_sort | diagnostic accuracy of risk assessment and fecal immunochemical test in colorectal cancer screening results from a population based program and meta analysis |
| topic | colorectal cancer diagnostic accuracy fecal immunochemical test risk assessment screening |
| url | https://doi.org/10.1002/cam4.6399 |
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