title: Fecal Immunochemical Test Program Performance Over 4 Rounds of Annual Screening: A Retrospective Cohort Study.
abstract: BACKGROUND
  The fecal immunochemical test (FIT) is a common method for colorectal cancer (CRC) screening, yet its acceptability and performance over several rounds of annual testing are largely unknown.
  
  
  OBJECTIVE
  To assess FIT performance characteristics over 4 rounds of annual screening.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Kaiser Permanente Northern and Southern California.
  
  
  METHODS
  323 349 health plan members aged 50 to 70 years on their FIT mailing date in 2007 or 2008 who completed the first round of FIT and were followed for up to 4 screening rounds.
  
  
  METHODS
  Screening participation, FIT positivity (≥20 µg of hemoglobin/g), positive predictive values for adenoma and CRC, and FIT sensitivity for detecting CRC obtained from Kaiser Permanente electronic databases and cancer registries.
  
  
  RESULTS
  Of the patients invited for screening, 48.2% participated in round 1. Of those who remained eligible, 75.3% to 86.1% participated in subsequent rounds. Median follow-up was 4.0 years, and 32% of round 1 participants crossed over to endoscopy over 4 screening rounds-7.0% due to a positive FIT result. The FIT positivity rate (5.0%) and positive predictive values (adenoma, 51.5%; CRC, 3.4%) were highest in round 1. Overall, programmatic FIT screening detected 80.4% of patients with CRC diagnosed within 1 year of testing, including 84.5% in round 1 and 73.4% to 78.0% in subsequent rounds.
  
  
  CONCLUSIONS
  Screening detection, rather than long-term cancer prevention, was evaluated.
  
  
  CONCLUSIONS
  Annual FIT screening was associated with high sensitivity for CRC, with high adherence to annual follow-up screening among initial participants. The findings indicate that annual programmatic FIT screening is feasible and effective for population-level CRC screening.
  
  
  BACKGROUND
  National Institutes of Health.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Jensen
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Corley
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.forename: Chyke A
authors.initials: CA
authors.lastname: Doubeni
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Lee
authors.forename: Wei K
authors.initials: WK
authors.lastname: Zhao
authors.forename: Amy R
authors.initials: AR
authors.lastname: Marks
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Schottinger
authors.forename: Nirupa R
authors.initials: NR
authors.lastname: Ghai
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Lee
authors.forename: Richard
authors.initials: R
authors.lastname: Contreras
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Levin
authors.forename: Pauline A
authors.initials: PA
authors.lastname: Mysliwiec
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
references.citation: J Natl Cancer Inst. 2007 Oct 3;99(19):1462-70
references.pmid: 17895475
references.citation: Gastrointest Endosc. 2015 Jan;81(1):31-53
references.pmid: 25480100
references.citation: Lancet. 1996 Nov 30;348(9040):1472-7
references.pmid: 8942775
references.citation: Ann Intern Med. 2008 Nov 4;149(9):659-69
references.pmid: 18838717
references.citation: N Engl J Med. 2012 Feb 23;366(8):697-706
references.pmid: 22356323
references.citation: Am J Gastroenterol. 2006 Apr;101(4):873-85
references.pmid: 16635231
references.citation: Gut. 2009 Apr;58(4):530-5
references.pmid: 19036949
references.citation: Clin Gastroenterol Hepatol. 2013 Feb;11(2):172-80
references.pmid: 22985608
references.citation: CA Cancer J Clin. 2009 Jul-Aug;59(4):225-49
references.pmid: 19474385
references.citation: N Engl J Med. 2000 Nov 30;343(22):1603-7
references.pmid: 11096167
references.citation: Lancet. 1996 Nov 30;348(9040):1467-71
references.pmid: 8942774
references.citation: Gastroenterology. 2008 May;134(5):1570-95
references.pmid: 18384785
references.citation: JAMA Intern Med. 2013 Oct 14;173(18):1725-32
references.pmid: 23921906
references.citation: Am J Gastroenterol. 2009 Mar;104(3):739-50
references.pmid: 19240699
references.citation: CA Cancer J Clin. 2008 May-Jun;58(3):130-60
references.pmid: 18322143
references.citation: Arch Intern Med. 2012 Apr 9;172(7):575-82
references.pmid: 22493463
references.citation: Gastroenterology. 2008 Jul;135(1):82-90
references.pmid: 18482589
references.citation: CA Cancer J Clin. 2013 Jan;63(1):11-30
references.pmid: 23335087
references.citation: Ann Intern Med. 2014 Feb 4;160(3):171
references.pmid: 24658694
references.citation: Am J Public Health. 1992 May;82(5):703-10
references.pmid: 1566949
references.citation: Cancer. 2010 Feb 1;116(3):544-73
references.pmid: 19998273
references.citation: J Natl Cancer Inst. 1999 Mar 3;91(5):434-7
references.pmid: 10070942
references.citation: Perm J. 2012 Summer;16(3):37-41
references.pmid: 23012597
references.citation: Gastroenterology. 2004 Jun;126(7):1674-80
references.pmid: 15188160
references.citation: Endoscopy. 2013;45(1):27-34
references.pmid: 23254404
references.citation: Epidemiol Rev. 2011;33:101-10
references.pmid: 21709143
references.citation: N Engl J Med. 1993 May 13;328(19):1365-71
references.pmid: 8474513
references.citation: Ann Intern Med. 2008 Nov 4;149(9):627-37
references.pmid: 18838716
references.citation: Clin Gastroenterol Hepatol. 2012 Jun;10(6):633-8
references.pmid: 22426085
references.citation: Cancer. 2006 Nov 1;107(9):2152-9
references.pmid: 16998938