title: Guaiac faecal occult blood test performance at initial and repeat screens in the English Bowel Cancer Screening Programme.
abstract: BACKGROUND
  In many countries, screening for colorectal cancer (CRC) relies on repeat testing using the guaiac faecal occult blood test (gFOBT). This study aimed to compare gFOBT performance measures between initial and repeat screens.
  
  
  METHODS
  Data on screening uptake and outcomes from the English Bowel Cancer Screening Programme (BCSP) for the years 2008 and 2011 were used. An existing CRC natural history model was used to estimate gFOBT sensitivity and specificity, and the cost-effectiveness of different screening strategies.
  
  
  RESULTS
  The gFOBT sensitivity for CRC was estimated to decrease from 27.35% at the initial screen to 20.22% at the repeat screen. Decreases were also observed for the positive predictive value (8.4-7.2%) and detection rate for CRC (0.19-0.14%). Assuming equal performance measures for both the initial and repeat screens led to an overestimate of the cost effectiveness of gFOBT screening compared with the other screening modalities.
  
  
  CONCLUSIONS
  Performance measures for gFOBT screening were generally lower in the repeat screen compared with the initial screen. Screening for CRC using gFOBT is likely to be cost-effective; however, the use of different screening modalities may result in additional benefits. Future economic evaluations of gFOBT should not assume equal sensitivities between screening rounds.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
authors.forename: B
authors.initials: B
authors.lastname: Kearns
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
authors.forename: S
authors.initials: S
authors.lastname: Whyte
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
authors.forename: J
authors.initials: J
authors.lastname: Chilcott
authors.affiliation: Public Health England, Sheffield S10 3TH, UK.
authors.forename: J
authors.initials: J
authors.lastname: Patnick
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006138:Guaiac; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011379:Prognosis
chemical_list: D006138:Guaiac