Manuel Zorzi1, Cesare Hassan2, Giulia Capodaglio3, Elena Narne4, Anna Turrin4, Maddalena Baracco1, Antonella Dal Cin1, Annarita Fiore1, Giancarla Martin1, Alessandro Repici5, Douglas Rex6, Massimo Rugge7. 1. Veneto Tumour Registry, Azienda Zero, Padova, Italy (M.Z., M.B., A.D., A.F., G.M.). 2. Nuovo Regina Margherita Hospital, Rome, Italy (C.H.). 3. Regional Epidemiology Service, Azienda Zero, Padova, Italy (G.C.). 4. Screening and Health Impact Evaluation, Azienda Zero, Padova, Italy (E.N., A.T.). 5. Humanitas University, Rozzano (Milan), Italy (A.R.). 6. Indiana University Medical Center, Indianapolis, Indiana (D.R.). 7. Veneto Tumour Registry and University of Padova, Padova, Italy (M.R.).
Abstract
Background: Short-term studies have reported that the fecal immunochemical test (FIT) is less accurate in detecting proximal than distal colorectal neoplasia. Objective: To assess the long-term detection rates for advanced adenoma and colorectal cancer (CRC), according to anatomical location. Design: Retrospective study. Setting: Population-based, organized screening program in the Veneto region of Italy. Participants: Persons aged 50 to 69 years who completed 6 rounds of FIT screening. Measurements: At each screening round, the detection rates for advanced adenoma and cancer, as well as the proportional interval cancer rate (PICR), were calculated by anatomical location (proximal colon, distal colon, or rectum). Results: Between 2002 and 2014, a total of 123 347 participants had 441 647 FITs. The numbers of advanced adenomas and cancer cases detected, respectively, were 1704 and 200 in the proximal colon, 3703 and 324 in the distal colon, and 1220 and 209 in the rectum. Although the detection rate for proximal colon cancer declined only from the first to the second screening round (0.63 to 0.36 per 1000 screenees), the rate for both distal colon and rectal cancer steadily decreased across 6 rounds (distal colon, 1.65 in the first round to 0.17 in the sixth; rectum, 0.82 in the first round to 0.17 in the sixth). Similar trends were found for advanced adenoma (proximal colon, 5.32 in the first round to 4.22 in the sixth; distal colon, 15.2 in the first round to 5.02 in the sixth). Overall, 150 cases of interval cancer were diagnosed. The PICR was higher in the proximal colon (25.2% [95% CI, 19.9% to 31.5%]) than the distal colon (6.0% [CI, 3.9% to 8.9%]) or rectum (9.9% [CI, 6.9% to 13.7%]). Limitations: Participants with irregular attendance were censored. Those who had a false-positive result on a previous FIT but negative colonoscopy results were included in subsequent rounds. Conclusion: This FIT-based, multiple-round, long-term screening program had a negligible reduction in detection rates for neoplastic lesions in the proximal versus the distal colon after the first round. This was related to a higher PICR in the proximal colon and suboptimal efficacy in preventing the age-related proximal shifting of CRC. Primary Funding Source: None.
Background: Short-term studies have reported that the fecal immunochemical test (FIT) is less accurate in detecting proximal than distal colorectal neoplasia. Objective: To assess the long-term detection rates for advanced adenoma and colorectal cancer (CRC), according to anatomical location. Design: Retrospective study. Setting: Population-based, organized screening program in the Veneto region of Italy. Participants: Persons aged 50 to 69 years who completed 6 rounds of FIT screening. Measurements: At each screening round, the detection rates for advanced adenoma and cancer, as well as the proportional interval cancer rate (PICR), were calculated by anatomical location (proximal colon, distal colon, or rectum). Results: Between 2002 and 2014, a total of 123 347 participants had 441 647 FITs. The numbers of advanced adenomas and cancer cases detected, respectively, were 1704 and 200 in the proximal colon, 3703 and 324 in the distal colon, and 1220 and 209 in the rectum. Although the detection rate for proximal colon cancer declined only from the first to the second screening round (0.63 to 0.36 per 1000 screenees), the rate for both distal colon and rectal cancer steadily decreased across 6 rounds (distal colon, 1.65 in the first round to 0.17 in the sixth; rectum, 0.82 in the first round to 0.17 in the sixth). Similar trends were found for advanced adenoma (proximal colon, 5.32 in the first round to 4.22 in the sixth; distal colon, 15.2 in the first round to 5.02 in the sixth). Overall, 150 cases of interval cancer were diagnosed. The PICR was higher in the proximal colon (25.2% [95% CI, 19.9% to 31.5%]) than the distal colon (6.0% [CI, 3.9% to 8.9%]) or rectum (9.9% [CI, 6.9% to 13.7%]). Limitations: Participants with irregular attendance were censored. Those who had a false-positive result on a previous FIT but negative colonoscopy results were included in subsequent rounds. Conclusion: This FIT-based, multiple-round, long-term screening program had a negligible reduction in detection rates for neoplastic lesions in the proximal versus the distal colon after the first round. This was related to a higher PICR in the proximal colon and suboptimal efficacy in preventing the age-related proximal shifting of CRC. Primary Funding Source: None.
Authors: Esmée J Grobbee; Pieter Ha Wisse; Eline H Schreuders; Aafke van Roon; Leonie van Dam; Ann G Zauber; Iris Lansdorp-Vogelaar; Wichor Bramer; Sarah Berhane; Jonathan J Deeks; Ewout W Steyerberg; Monique E van Leerdam; Manon Cw Spaander; Ernst J Kuipers Journal: Cochrane Database Syst Rev Date: 2022-06-06
Authors: Catherine L Forse; Stephanie Petkiewicz; Iris Teo; Bibianna Purgina; Kristina-Ana Klaric; Tim Ramsay; Jason K Wasserman Journal: J Can Assoc Gastroenterol Date: 2021-12-16
Authors: Olalla Otero-Estévez; María Gallardo-Gomez; María Páez de la Cadena; Francisco Javier Rodríguez-Berrocal; Joaquín Cubiella; Vicent Hernandez Ramirez; Laura García-Nimo; Loretta De Chiara Journal: Diagnostics (Basel) Date: 2020-06-28
Authors: Jason D Eckmann; Derek W Ebner; Jamie Bering; Allon Kahn; Eduardo Rodriguez; Mary E Devens; Kari L Lowrie; Karen Doering; Sara Then; Kelli N Burger; Douglas W Mahoney; David O Prichard; Michael B Wallace; Suryakanth R Gurudu; Lila J Finney; Paul Limburg; Barry Berger; David A Ahlquist; John B Kisiel Journal: Am J Gastroenterol Date: 2020-04 Impact factor: 12.045