Increased uptake and improved outcomes of bowel cancer screening with a faecal immunochemical test: results from a pilot study within the national screening programme in England.
The National Health Service Bowel Cancer Screening Programme (BCSP) in England uses a guaiac-based faecal occult blood test (gFOBt). A quantitative faecal immunochemical test (FIT) for haemoglobin (Hb) has many advantages, including being specific forhumanblood, detecting Hb at a much lower concentration with a single faecal sample and improved uptake.



In 2014, a large comparative pilot study was performed within BCSP to establish the acceptability and diagnostic performance of FIT. Over a 6-month period, 40 930 (1 in 28) subjects were sent a FIT (OC-SENSOR) instead of a gFOBt. A bespoke FIT package was used to mail FIT sampling devices to and from FIT subjects. All participants positive with either gFOBt or FIT (cut-off 20 µg Hb/g faeces) were referred for follow-up. Subgroup analysis included cut-off concentrations, age, sex, screening history and deprivation quintile.



While overall uptake increased by over 7 percentage points with FIT (66.4% vs 59.3%, OR 1.35, 95% CI 1.33 to 1.38), uptake by previous non-responders almost doubled (FIT 23.9% vs gFOBt 12.5%, OR 2.20, 95% CI 2.10 to 2.29). The increase in overall uptake was significantly higher in men than women and was observed across all deprivation quintiles. With the conventional 20 µg/g cut-off, FIT positivity was 7.8% and ranged from 5.7% in 59-64-year-old women to 11.1% in 70-75-year-old men. Cancer detection increased twofold and that for advanced adenomas nearly fivefold. Detection rates remained higher with FIT for advanced adenomas, even at 180 µg Hb/g.



Markedly improved participation rates were achieved in a mature gFOBt-based national screening programme and disparities between men and women were reduced. High positivity rates, particularly in men and previous non-respondents, challenge the available colonoscopy resource, but improvements in neoplasia detection are still achievable within this limited resource.
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Sue
S
Moss
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Christopher
C
Mathews
NHS Cancer Screening Programmes, Sheffield, UK.
T J
TJ
Day
NHS Bowel Cancer Screening Midlands and North West Programme Hub, Rugby, UK.
Steve
S
Smith
NHS Bowel Cancer Screening Southern Programme Hub, Guildford, UK.
Helen E
HE
Seaman
NHS Bowel Cancer Screening Southern Programme Hub, Guildford, UK.
Julia
J
Snowball
NHS Bowel Cancer Screening Southern Programme Hub, Guildford, UK.|University of Surrey, Guildford, UK.
Stephen P
SP
Halloran
D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D004739:England / Q000453:epidemiology; D005243:Feces; D005260:Female; D006138:Guaiac / Q000494:pharmacology; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007120:Immunochemistry / Q000379:methods; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010043:Outcome and Process Assessment, Health Care; D010358:Patient Participation / Q000706:statistics & numerical data*; D010865:Pilot Projects; D058996:Quality Improvement
D006454:Hemoglobins; D006138:Guaiac
COLORECTAL CANCER SCREENING; COLORECTAL NEOPLASIA; EPIDEMIOLOGY