title: Comparison of One versus Two Fecal Immunochemical Tests in the Detection of Colorectal Neoplasia in a Population-Based Colorectal Cancer Screening Program.
abstract: Objective.To determine the positive predictive value (PPV) of two versus one abnormal FIT in the detection of colorectal neoplasia in a Canadian population.Methods.Three communities enrolled in a colorectal cancer (CRC) screening pilot program from 01/2009 to 04/2013 using 2 FITs. Data collected included demographics, colonoscopy, pathology, and FIT results. Participants completed both FITs and had one positive FIT and colonoscopy. PPV of one versus two abnormal FITs was calculated using a weighted-generalized score statistic. A two-sided 5% significance level was used.Results.1576 of 17,031 average-risk participants, 50-75 years old, had a positive FIT. Colonoscopy revealed 58 (3.7%) cancers, 419 (31.6%) high-risk polyps, and 374 (23.7%) low-risk polyps as the most significant lesion. PPV of one versus two positive FITs for cancer, high-risk polyps, and any neoplasia were 1% versus 8%, 20% versus 40%, and 48% versus 67%, respectively (pvalue < 0.0001). When the first FIT was negative, the second positive FIT detected 7 CRCs and 98 high-risk polyps.Conclusions.PPV of two positive FITs is superior to one positive FIT for CRC and high-risk polyps. The added value of the second FIT was 12% of total CRCs and 23% of total high-risk polyps.
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Sarvenaz
authors.identifier: 0000-0001-7960-6555
authors.initials: S
authors.lastname: Moosavi
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Robert
authors.identifier: 0000-0002-9018-4522
authors.initials: R
authors.lastname: Enns
authors.affiliation: British Columbia Cancer Agency, Colon Screening Program, Hereditary Cancer Program, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Laura
authors.identifier: 0000-0001-5392-0650
authors.initials: L
authors.lastname: Gentile
authors.affiliation: British Columbia Cancer Agency, Colon Screening Program, Hereditary Cancer Program, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Lovedeep
authors.identifier: 0000-0002-1707-8141
authors.initials: L
authors.lastname: Gondara
authors.affiliation: British Columbia Cancer Agency, Colon Screening Program, Hereditary Cancer Program, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: McGahan
authors.affiliation: Division of Gastroenterology & Hepatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Telford
mesh_terms: D000368:Aged; D002170:Canada; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007120:Immunochemistry; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012307:Risk Factors