Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic
Autor: | Rocío Aznar-Gimeno, Patricia Carrera-Lasfuentes, Rafael del-Hoyo-Alonso, Manuel Doblaré, Ángel Lanas |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
screening fecal-immunological test
Medicine (General) Evidence-based practice Colorectal cancer Population Colonoscopy colorectal cancer 03 medical and health sciences 0302 clinical medicine R5-920 colonoscopy Pandemic medicine education Selection (genetic algorithm) Original Research education.field_of_study medicine.diagnostic_test Crc screening business.industry adenomas decision-making General Medicine medicine.disease Cut off point 030220 oncology & carcinogenesis Medicine 030211 gastroenterology & hepatology business Demography |
Zdroj: | Frontiers in Medicine Frontiers in Medicine, Vol 8 (2021) Zaguán. Repositorio Digital de la Universidad de Zaragoza Consejo Superior de Investigaciones Científicas (CSIC) |
ISSN: | 2296-858X |
DOI: | 10.3389/fmed.2021.712040 |
Popis: | Background: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs. Resuming these programs is a priority, but fewer colonoscopies may be available. We developed an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC.Methods: We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/2018. We investigated two different scenarios: not modifying vs. modifying the FIT cut-off value. We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed).Results: The current FIT cut-off (20-μg hemoglobin/g feces) led to 6,606 colonoscopies per 100,000 people invited annually. Without modifying this FIT cut-off value, when the optimal number of individuals invited for colonoscopies was reduced by 10–40%, a high number of CRCs and high-risk adenomas (34–135 and 73–288/100.000-people invited, respectively) will be undetected every year. When the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability, the number of missed lesions per year was remarkably reduced (9–36 and 29–145/100.000 people, respectively). Moreover, the unmodified FIT scenario outcome was improved by prioritizing the selection process based on sex (males) and age, rather than randomly reducing the number invited.Conclusions: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors to prioritize access to colonoscopies should be also considered. |
Databáze: | OpenAIRE |
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