Olusegun I Alatise1, Anna J Dare2, Patrick A Akinyemi3, Fatimah B Abdulkareem4, Samuel A Olatoke5, Gregory C Knapp6, T Peter Kingham7. 1. Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Osun, Nigeria; African Research Group for Oncology, Osun, Nigeria. 2. African Research Group for Oncology, Osun, Nigeria; Department of Surgery, and Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 3. African Research Group for Oncology, Osun, Nigeria. 4. Department of Anatomic and Molecular Pathology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria. 5. Department of Surgery, University of Ilorin Teaching Hospital, Kwara, Nigeria. 6. African Research Group for Oncology, Osun, Nigeria; Department of Surgery, Division of General Surgery, Dalhousie University, Nova Scotia, Canada. 7. African Research Group for Oncology, Osun, Nigeria; Department of Surgery, and Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: kinghamt@mskcc.org.
Abstract
BACKGROUND: The estimated incidence of colorectal cancer is rising in Nigeria, where most patients present with advanced disease. Earlier detection of colorectal cancer is a goal of the Nigerian National Cancer Control Plan, but the utility of fecal-based screening is unclear. This study aimed to assess the fecal immunochemical test as a colorectal cancer screening modality in average-risk individualS in Nigeria. METHODS: A population-based, cross-sectional study of qualitative fecal immunochemical test-based colorectal cancer screening was done in asymptomatic, average-risk participants aged 45-75 years in three states in Nigeria (Osun, Kwara, and Lagos). Participants were invited to enrol using age-stratified and sex-stratified convenience sampling following community outreach. Exclusion criteria included a personal history of colorectal cancer or rectal bleeding in the previous 6 months, a first-degree relative with a known diagnosis of colorectal cancer, or a comorbidity that would preclude conscious sedation or general anesthesia. Participants with positive fecal immunochemical test results underwent colonoscopy, and the positive predictive value of fecal immunochemical testing for colorectal cancer and advanced adenomas (≥10 mm, tubulovillous or villous or high-grade dysplasia) was calculated. Data on demographics and acceptability of fecal immunochemical testing and colonoscopy were collected. FINDINGS: Between January and April 2021, 2330 participants were enrolled in the study and received a fecal immunochemical test, which was returned by 2109 participants. 1677 participants tested negative and 432 tested positive. Of these 432 participants, 285 underwent a colonoscopy (235 showed no polyps or cancer, 47 had polyps identified, and three had colorectal cancer identified). Of the 47 participants who had polyps identified, 20 had advanced adenomas diagnosed. The median age was 57 years (IQR 50-63), 958 (41%) were male and 1372 (59%) were female, and 68% had at least a secondary-level education. Participants were evenly spread across wealth quintiles. The positivity rate of the fecal immunochemical test was 21% overall (432 of 2109; 95% CI 20-21%), 11% (51 of 455; 95% CI 10-12) in Lagos, 20% (215 of 1052; 95% CI 20-21) in Osun, and 28% (166 of 597; 95% CI 27-29) in Kwara. Among the patients with a positive fecal immunochemical test who completed colonoscopy, the positive predictive value for invasive colorectal cancer was 1·1% (95% CI 0·3-3·3), and 7·0% (4·5-10·8) for advanced adenoma. The acceptability of fecal immunochemical screening among participants was very high. INTERPRETATION: Colorectal cancer screening with qualitative fecal immunochemical tests in Nigeria is feasible and acceptable to average-risk asymptomatic participants. However, the low positive predictive value for advanced neoplasia and high endoscopy burden investigating false positives suggests it might not be an appropriate screening tool in this setting. FUNDING: Thompson Family Foundation, Prevent Cancer Foundation, National Institutes of Health/National Cancer Institute Program Cancer Center.
BACKGROUND: The estimated incidence of colorectal cancer is rising in Nigeria, where most patients present with advanced disease. Earlier detection of colorectal cancer is a goal of the Nigerian National Cancer Control Plan, but the utility of fecal-based screening is unclear. This study aimed to assess the fecal immunochemical test as a colorectal cancer screening modality in average-risk individualS in Nigeria. METHODS: A population-based, cross-sectional study of qualitative fecal immunochemical test-based colorectal cancer screening was done in asymptomatic, average-risk participants aged 45-75 years in three states in Nigeria (Osun, Kwara, and Lagos). Participants were invited to enrol using age-stratified and sex-stratified convenience sampling following community outreach. Exclusion criteria included a personal history of colorectal cancer or rectal bleeding in the previous 6 months, a first-degree relative with a known diagnosis of colorectal cancer, or a comorbidity that would preclude conscious sedation or general anesthesia. Participants with positive fecal immunochemical test results underwent colonoscopy, and the positive predictive value of fecal immunochemical testing for colorectal cancer and advanced adenomas (≥10 mm, tubulovillous or villous or high-grade dysplasia) was calculated. Data on demographics and acceptability of fecal immunochemical testing and colonoscopy were collected. FINDINGS: Between January and April 2021, 2330 participants were enrolled in the study and received a fecal immunochemical test, which was returned by 2109 participants. 1677 participants tested negative and 432 tested positive. Of these 432 participants, 285 underwent a colonoscopy (235 showed no polyps or cancer, 47 had polyps identified, and three had colorectal cancer identified). Of the 47 participants who had polyps identified, 20 had advanced adenomas diagnosed. The median age was 57 years (IQR 50-63), 958 (41%) were male and 1372 (59%) were female, and 68% had at least a secondary-level education. Participants were evenly spread across wealth quintiles. The positivity rate of the fecal immunochemical test was 21% overall (432 of 2109; 95% CI 20-21%), 11% (51 of 455; 95% CI 10-12) in Lagos, 20% (215 of 1052; 95% CI 20-21) in Osun, and 28% (166 of 597; 95% CI 27-29) in Kwara. Among the patients with a positive fecal immunochemical test who completed colonoscopy, the positive predictive value for invasive colorectal cancer was 1·1% (95% CI 0·3-3·3), and 7·0% (4·5-10·8) for advanced adenoma. The acceptability of fecal immunochemical screening among participants was very high. INTERPRETATION: Colorectal cancer screening with qualitative fecal immunochemical tests in Nigeria is feasible and acceptable to average-risk asymptomatic participants. However, the low positive predictive value for advanced neoplasia and high endoscopy burden investigating false positives suggests it might not be an appropriate screening tool in this setting. FUNDING: Thompson Family Foundation, Prevent Cancer Foundation, National Institutes of Health/National Cancer Institute Program Cancer Center.
Authors: Jeffrey K Lee; Elizabeth G Liles; Stephen Bent; Theodore R Levin; Douglas A Corley Journal: Ann Intern Med Date: 2014-02-04 Impact factor: 25.391
Authors: Douglas K Rex; Philip S Schoenfeld; Jonathan Cohen; Irving M Pike; Douglas G Adler; M Brian Fennerty; John G Lieb; Walter G Park; Maged K Rizk; Mandeep S Sawhney; Nicholas J Shaheen; Sachin Wani; David S Weinberg Journal: Gastrointest Endosc Date: 2014-12-02 Impact factor: 9.427
Authors: David O Irabor; Olayiwola A Oluwasola; Olufemi J Ogunbiyi; Olabiyi G Ogun; Clement A Okolo; Marilena Melas; Stephen B Gruber; Chanjuan Shi; Leon Raskin Journal: Anticancer Res Date: 2017-05 Impact factor: 2.480
Authors: Douglas K Rex; C Richard Boland; Jason A Dominitz; Francis M Giardiello; David A Johnson; Tonya Kaltenbach; Theodore R Levin; David Lieberman; Douglas J Robertson Journal: Gastroenterology Date: 2017-06-09 Impact factor: 22.682
Authors: Enrique Quintero; Antoni Castells; Luis Bujanda; Joaquín Cubiella; Dolores Salas; Ángel Lanas; Montserrat Andreu; Fernando Carballo; Juan Diego Morillas; Cristina Hernández; Rodrigo Jover; Isabel Montalvo; Juan Arenas; Eva Laredo; Vicent Hernández; Felipe Iglesias; Estela Cid; Raquel Zubizarreta; Teresa Sala; Marta Ponce; Mercedes Andrés; Gloria Teruel; Antonio Peris; María-Pilar Roncales; Mónica Polo-Tomás; Xavier Bessa; Olga Ferrer-Armengou; Jaume Grau; Anna Serradesanferm; Akiko Ono; José Cruzado; Francisco Pérez-Riquelme; Inmaculada Alonso-Abreu; Mariola de la Vega-Prieto; Juana Maria Reyes-Melian; Guillermo Cacho; José Díaz-Tasende; Alberto Herreros-de-Tejada; Carmen Poves; Cecilio Santander; Andrés González-Navarro Journal: N Engl J Med Date: 2012-02-23 Impact factor: 91.245
Authors: Douglas J Robertson; Jeffrey K Lee; C Richard Boland; Jason A Dominitz; Francis M Giardiello; David A Johnson; Tonya Kaltenbach; David Lieberman; Theodore R Levin; Douglas K Rex Journal: Am J Gastroenterol Date: 2016-10-18 Impact factor: 10.864
Authors: Iris Lansdorp-Vogelaar; Marjolein van Ballegooijen; Ann G Zauber; Rob Boer; Janneke Wilschut; Sidney J Winawer; J Dik F Habbema Journal: Gastrointest Endosc Date: 2009-05-24 Impact factor: 9.427
Authors: Gregory C Knapp; Olusegun Alatise; Bolatito Olopade; Marguerite Samson; Olalekan Olasehinde; Funmilola Wuraola; Oluwole O Odujoko; Akinwunmi O Komolafe; Olujide O Arije; Philip E Castle; J Joshua Smith; Martin R Weiser; T Peter Kingham Journal: PLoS One Date: 2021-01-12 Impact factor: 3.240