Sisse Helle Njor1,2,3, Berit Andersen1,2,3, Lennart Friis-Hansen3,4, Niels de Haas3,5, Dorte Linnemann3,6, Henrik Nørgaard3,7, Ole Roikjaer3,8, Bo Søndergaard3,9, Morten Rasmussen3,10. 1. Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark. 2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 3. Danish Colorectal Cancer Screening Database (DCCSD) Steering Committee, Aarhus, Denmark. 4. Department of Clinical Biochemistry, Hilleroed Hospital, Hillerød, Denmark. 5. Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark. 6. Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark. 7. Department of Radiology, Herlev Hospital, Herlev, Denmark. 8. Department of Surgery, Zealand University Hospital, Roskilde, Denmark. 9. Gastrounit, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark. 10. Bispebjerg University Hospital, Copenhagen, Denmark.
Abstract
BACKGROUND: Colorectal cancer (CRC) screening programs using fecal immunochemical test (FIT) have to choose a cut-off value to decide which citizens to recall for colonoscopy. The evidence on the optimal cut-off value is sparse and based on studies with a low number of cancer cases. METHODS: This observational study used data from the Danish Colorectal Cancer Screening Database. Sensitivity and specificity were estimated for various cut-off values based on a large number of cancers. Traditionally optimal cut-off values are found by weighting sensitivity and specificity equally. As this might result in too many unnecessary colonoscopies we also provide optimal cut-off values for different weighting of sensitivity and specificity/number of needed colonoscopies to detect one cancer. RESULTS: Weighting sensitivity and specificity equally gives an optimal cut-off value of 45 ng Hb/ml. This, however, means making 24 colonoscopies to detect one cancer. Weighting sensitivity lower and for example, aiming at making about 16 colonoscopies to detect one cancer, gives an optimal cut-off value of 125 ng Hb/ml. CONCLUSIONS: The optimal cut-off value in an FIT population-based screening program is 45 ng Hb/ml, when as traditionally sensitivity and specificity are weighted equally. If, however, 24 colonoscopies needed to detect one cancer is too huge a burden on the health care system and the participants, 80, 125, 175, and 350 ng Hb/ml are optimal cut-off values when only 19/16/14/10 colonoscopies are accepted to find one cancer.
BACKGROUND:Colorectal cancer (CRC) screening programs using fecal immunochemical test (FIT) have to choose a cut-off value to decide which citizens to recall for colonoscopy. The evidence on the optimal cut-off value is sparse and based on studies with a low number of cancer cases. METHODS: This observational study used data from the Danish Colorectal Cancer Screening Database. Sensitivity and specificity were estimated for various cut-off values based on a large number of cancers. Traditionally optimal cut-off values are found by weighting sensitivity and specificity equally. As this might result in too many unnecessary colonoscopies we also provide optimal cut-off values for different weighting of sensitivity and specificity/number of needed colonoscopies to detect one cancer. RESULTS: Weighting sensitivity and specificity equally gives an optimal cut-off value of 45 ng Hb/ml. This, however, means making 24 colonoscopies to detect one cancer. Weighting sensitivity lower and for example, aiming at making about 16 colonoscopies to detect one cancer, gives an optimal cut-off value of 125 ng Hb/ml. CONCLUSIONS: The optimal cut-off value in an FIT population-based screening program is 45 ng Hb/ml, when as traditionally sensitivity and specificity are weighted equally. If, however, 24 colonoscopies needed to detect one cancer is too huge a burden on the health care system and the participants, 80, 125, 175, and 350 ng Hb/ml are optimal cut-off values when only 19/16/14/10 colonoscopies are accepted to find one cancer.
Authors: Sisse Helle Njor; Lennart Friis-Hansen; Berit Andersen; Bo Søndergaard; Dorte Linnemann; Jens Christian Riis Jørgensen; Ole Roikjær; Morten Rasmussen Journal: Cancer Epidemiol Date: 2018-10-04 Impact factor: 2.984
Authors: T R de Wijkerslooth; E M Stoop; P M Bossuyt; G A Meijer; M van Ballegooijen; A H C van Roon; I Stegeman; R A Kraaijenhagen; P Fockens; M E van Leerdam; E Dekker; E J Kuipers Journal: Am J Gastroenterol Date: 2012-07-31 Impact factor: 10.864
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