Diagnostic performance of a faecal immunochemical test for patients with low-risk symptoms of colorectal cancer in primary care: an evaluation in the South West of England
| Autor: | John Renninson, Sarah Warren, Catherine Neck, Willie Hamilton, Alex Atkins, Timothy J. McDonald, Paul A. Thomas, Sarah Jane Davies, Joe Mays, S. Bailey, Rachel Byford, Jon Miller, Gary A. Abel, Fiona M Walter |
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| Přispěvatelé: | Bailey, Sarah ER [0000-0003-0020-4778], Apollo - University of Cambridge Repository, Bailey, Sarah E. R. [0000-0003-0020-4778] |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Cancer Research Colorectal cancer Population Primary care Sensitivity and Specificity 03 medical and health sciences Gastrointestinal cancer Feces Hemoglobins 0302 clinical medicine Weight loss Risk Factors Internal medicine Weight Loss medicine 692/53/2421 Humans 030212 general & internal medicine 692/1807/1808 education education.field_of_study Anemia Iron-Deficiency Primary Health Care business.industry article Cancer Digestive signs and symptoms Diagnostic markers Middle Aged medicine.disease Triage Test (assessment) Oncology England 030220 oncology & carcinogenesis Occult Blood 692/699/67/1504 Female medicine.symptom business Colorectal Neoplasms |
| Zdroj: | British Journal of Cancer |
| Popis: | Background The faecal immunochemical test (FIT) was introduced to triage patients with low-risk symptoms of possible colorectal cancer in English primary care in 2017, underpinned by little primary care evidence. Methods All healthcare providers in the South West of England (population 4 million) participated in this evaluation. 3890 patients aged ≥50 years presenting in primary care with low-risk symptoms of colorectal cancer had a FIT from 01/06/2018 to 31/12/2018. A threshold of 10 μg Hb/g faeces defined a positive test. Results Six hundred and eighteen (15.9%) patients tested positive; 458 (74.1%) had an urgent referral to specialist lower gastrointestinal (GI) services within three months. Forty-three were diagnosed with colorectal cancer within 12 months. 3272 tested negative; 324 (9.9%) had an urgent referral within three months. Eight were diagnosed with colorectal cancer within 12 months. Positive predictive value was 7.0% (95% CI 5.1–9.3%). Negative predictive value was 99.8% (CI 99.5–99.9%). Sensitivity was 84.3% (CI 71.4–93.0%), specificity 85.0% (CI 83.8–86.1%). The area under the ROC curve was 0.92 (CI 0.86–0.96). A threshold of 37 μg Hb/g faeces would identify patients with an individual 3% risk of cancer. Conclusions FIT performs exceptionally well to triage patients with low-risk symptoms of colorectal cancer in primary care; a higher threshold may be appropriate in the wake of the COVID-19 crisis. |
| Databáze: | OpenAIRE |
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