Lower Abnormal Fecal Immunochemical Test Cut-Off Values Improve Detection of Colorectal Cancer in System-Level Screens复制标题

较低的异常粪便免疫化学检测临界值可提高系统水平筛查中的结直肠癌检测

Colorectal cancer (CRC) is the second leading cause Q16 of cancer death in the United States (ACS-CFF). Q15 Screening can reduce CRC incidence and mortality,1–6 but participation is suboptimal among underserved populations, particularly minorities and the uninsured.2,7–10 Noninvasive tests for CRC screening such as the fecal immunochemical test (FIT) have been linked to higher participation rates,6,11–13 but have lower sensitivity for CRC and advanced adenoma than colonoscopy. Some FITs are quantitative and measure the absolute hemoglobin (Hgb) concentration within a stool sample. One strategy to improve neoplasia detection among individuals preferring FIT would be to decrease the Hgb concentration that would indicate an abnormal test  result requiring diagnostic colonoscopy. Prior work has suggested that a lower threshold can improve neoplasia detection; a meta-analysis of FIT performance found that  using a lower hemoglobin concentration cut-off value to designate an abnormal FIT optimized sensitivity for CRC: 89% for a cut-off value of less than 20 mg hemoglobin/g  feces vs 70% for cut-off values of 20 to 50 mg hemoglobin/g feces.14 A challenge of this approach, however, particularly in settings with constrained colonoscopy capacity,  is that decreasing the threshold also may increase colonoscopy demand. In the United States in particular, real-world data specific to the impact of using a lower Hgb concentration threshold for diagnostic colonoscopy demand and neoplasia detection when implemented within screening programs are sparse.

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