title: Impact of age- and gender-specific cut-off values for the fecal immunochemical test for hemoglobin in colorectal cancer screening.
abstract: BACKGROUND
  There is no information on the impact of age and gender on the diagnostic yield of different positivity thresholds for the fecal immunochemical test for hemoglobin (FIT).
  
  
  OBJECTIVE
  To evaluate the performance of this test at distinct positivity cut-offs in a population-based colorectal cancer (CRC) screening program.
  
  
  METHODS
  CRC detection rate (DR), and analysis of resources were evaluated retrospectively, at different cut-offs of FIT (20, 25, 30, 35 and 40μg Hb/g) respect to a reference value (15μg Hb/g), according to age and gender, in a screening population of 10,611 participants of the ColonPrev study (Quintero. NEJM 2013).
  
  
  RESULTS
  At the reference cut-off value, 36 CRC and 252 advanced adenomas (AA) were diagnosed. Increasing the cut-off in women ≤60 years decreases colonoscopies performed by 44.5% without modifying the CRC (DR). Same CRC DR was observed in men ≤60 years and women >60 years increasing cut-off at 25-30μg Hb/g. In men >60 years, all increases in the cut-off affected the CRC DR, especially when the cut-off was increased from 35 to 40μg Hb/g (CRC miss rate 25%).
  
  
  CONCLUSIONS
  To improve the performance of FIT in CRC screening programs, FIT cut-offs could be individualized by age and gender.
authors.affiliation: Department of Gastroenterology, Hospital del Mar, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Autonomous University of Barcelona and Pompeu Fabra University, Barcelona, Catalonia, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Alvarez-Urturi
authors.affiliation: Department of Gastroenterology, Hospital del Mar, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Autonomous University of Barcelona and Pompeu Fabra University, Barcelona, Catalonia, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Andreu
authors.affiliation: Department of Epidemiology and Evaluation, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Catalonia, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: Colorectal Cancer Prevention Program of Murcia, Dirección General de Salud Pública, Consejería de Sanidad y Política Social, Murcia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Perez-Riquelme
authors.affiliation: Colorectal Cancer Prevention Program of Murcia, Dirección General de Salud Pública, Consejería de Sanidad y Política Social, Murcia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Carballo
authors.affiliation: Colorectal Cancer Prevention Program of Murcia, Dirección General de Salud Pública, Consejería de Sanidad y Política Social, Murcia, Spain.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ono
authors.affiliation: Colorectal Cancer Prevention Program of Murcia, Dirección General de Salud Pública, Consejería de Sanidad y Política Social, Murcia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Cruzado
authors.affiliation: Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, IBIV - Institute of Biomedical Research of Vigo, Vigo, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cubiella
authors.affiliation: Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, IBIV - Institute of Biomedical Research of Vigo, Vigo, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Hernandez
authors.affiliation: Department of Clinical Analysis, Complexo Hospitalario Vigo, Vigo, Spain.
authors.forename: Carmen Gonzalez
authors.initials: CG
authors.lastname: Mao
authors.affiliation: Colorectal Cancer Screening Program, Dirección General de Salud Pública, València, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Perez
authors.affiliation: Colorectal Cancer Screening Program, Dirección General de Salud Pública, València, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Salas
authors.affiliation: Colorectal Cancer Screening Program, Dirección General de Salud Pública, València, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Andrés
authors.affiliation: Department of Gastroenterology, Donostia Hospital-Instituto Biodonostia, CIBERehd, University of Basque Country (UPV/EHU), San Sebastián, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Bujanda
authors.affiliation: Centro Coordinador del Programa de Cribado Cáncer Colorrectal, Organización Central de Osakidetza-Servicio Vasco de Salud, San Sebastián, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Portillo
authors.affiliation: Hospital Donostia, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarasqueta
authors.affiliation: Department of Gastroenterology, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Quintero
authors.affiliation: Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Juan Diego
authors.initials: JD
authors.lastname: Morillas
authors.affiliation: Department of Gastroenterology, University of Zaragoza, IIS Aragón, CIBERehd, Zaragoza, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
authors.affiliation: Department of Gastroenterology, University of Zaragoza, IIS Aragón, CIBERehd, Zaragoza, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sostres
authors.affiliation: Department of Biochemistry and Molecular Genetics, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Augé
authors.affiliation: Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Castells
authors.affiliation: Department of Gastroenterology, Hospital del Mar, Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Autonomous University of Barcelona and Pompeu Fabra University, Barcelona, Catalonia, Spain. Electronic address: xbessa@parcdesalutmar.cat.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bessa
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000367:Age Factors; D000368:Aged; D002278:Carcinoma in Situ / Q000175:diagnosis*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005243:Feces / Q000737:chemistry*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007118:Immunoassay; D007120:Immunochemistry; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012016:Reference Values; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D006454:Hemoglobins
keywords: Colorectal cancer screening; Cut-off values