19 Jun Fecal Testing Better At Detecting Colon Cancer Than Advanced Atypical Changes
MedicalResearch.com Interview with:
Anastasia Katsoula, MD MSc
Aristotle University of Thessaloniki
MedicalResearch.com: What is the background for this study?
Response: Early detection of colorectal cancer (CRC) has proven to be effective in reduction of cancer-related mortality. Fecal immunochemical testing (FIT) has been recently advocated for population-based screening for CRC in average-risk individuals due to its high accuracy and potential for adherence, based on results from previous systematic reviews and meta-analyses in average-risk populations. However, the potential role of FIT for screening of subjects at increased risk for CRC has not yet been elucidated, hence colonoscopy is currently the only recommended screening option for subjects at increased risk of CRC. We performed a systematic review and meta-analysis to explore the diagnostic accuracy of FIT for CRC or advanced neoplasia (AN) in patientswith personal or familial history of CRC, using colonoscopy as the reference standard.
MedicalResearch.com: What are the main findings?
Response: Using data from 12 diagnostic studies, we found that Fecal immunochemical testing has high overall diagnostic accuracy for colorectal cancer but moderate for advanced neoplasia in increased-risk individuals. Sensitivity was approximately 93% for CRC but quite lower (48%) for AN. Use of cutoff values between 15 to 25μg Hb/g feces had the best combination of sensitivity and specificity for both CRC and advanced neoplasia. A series of pre-specified sensitivity and sub-group analyses verified robustness of our findings. However, high degree of heterogeneity and wide confidence intervals of the pooled estimates attenuate the quality and validity of our conclusions.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Given FIT’s safety, simplicity, low cost and low discomfort at use, our results suggest that it could be used as an acceptable alternative non-interventional screening strategy for subjects at increased risk for colorectal cancer who refuse to use colonoscopy. In real world settings, repeat use of Fecal immunochemical testing and higher compliance to screening schedule could counterbalance the superior accuracy of colonoscopy in diagnosis of AN. Moreover, offering multiple screening options means screening can be tailored to individual preferences and values, hence enabling a patient-centered approach.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We recommend further research with randomized controlled trials to evaluate the effectiveness of screening strategies based on FIT (alone or in combination with other screening options) for increased-risk individuals. Moreover, future studies should assess the cost-effectiveness of FIT for screening of individuals at high risk.
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Katsoula A, Paschos P, Haidich A, Tsapas A, Giouleme O. Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk for Colorectal CancerA Meta-analysis. JAMA Intern Med. Published online June 19, 2017. doi:10.1001/jamainternmed.2017.2309
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