The optimal cut-off value in fit-based colorectal cancer screening: An observational study

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DOI

  • Sisse Helle Njor
  • Berit Andersen
  • Lennart Friis-Hansen, Department of Clinical Biochemistry, Hilleroed Hospital, Hilleroed, Denmark; Member of Danish Colorectal Cancer Screening Database (DCCSD) steering committee., Denmark
  • Niels Daniel Hansen de Haas, Aalborg University
  • ,
  • Dorte Linnemann, Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark; Member of Danish Colorectal Cancer Screening Database (DCCSD) steering committee, Denmark.
  • ,
  • Henrik Nørgaard, Department of Radiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark., Danish Colorectal Cancer Screening Database (DCCSD) steering committee, Denmark
  • Ole Roikjær, Department of Surgery, Zealand University Hospital, Roskilde, Denmark; Member of Danish Colorectal Cancer Screening Database (DCCSD) steering committee, Denmark.
  • ,
  • Bo Søndergaard, Gastrounit, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark; Member of Danish Colorectal Cancer Screening Database (DCCSD) steering committee, Denmark.
  • ,
  • Morten Rasmussen, Bispebjerg Hospital, Bispebjerg, Danish Colorectal Cancer Screening Database (DCCSD) steering committee
Background:
Colorectal cancer (CRC) screening programs using fecal immunochemical test (FIT) have to choose a cut-off value to decide which citizens to recall
for colonoscopy. The evidence on the optimal cut-off value is sparse and based on studies with a low number of cancer cases.

Methods:
This observational study used data from the Danish Colorectal Cancer
Screening Database. Sensitivity and specificity were estimated for various cut-off
values based on a large number of cancers. Traditionally optimal cut-off values are found by weighting sensitivity and specificity equally. As this might result in too many unnecessary colonoscopies we also provide optimal cut-off values for different weighting of sensitivity and specificity/number of needed colonoscopies to detect one cancer.

Results:
Weighting sensitivity and specificity equally gives an optimal cut-off value of 45 ng Hb/ml. This, however, means making 24 colonoscopies to detect one cancer. Weighting sensitivity lower and for example, aiming at making about 16 colonoscopies to detect one cancer, gives an optimal cut-off value of 125 ng Hb/ml.

Conclusions:
The optimal cut-off value in an FIT population-based screening program is 45 ng Hb/ml, when as traditionally sensitivity and specificity are weighted equally. If, however, 24 colonoscopies needed to detect one cancer is too huge a burden on the health care system and the participants, 80, 125, 175, and 350 ng Hb/ml are optimal cut-off values when only 19/16/14/10 colonoscopies are accepted to find one cancer.
Original languageEnglish
JournalCancer Medicine
Volume10
Issue5
Pages (from-to)1872-1879
Number of pages8
DOIs
Publication statusPublished - Mar 2021

    Research areas

  • capacity building, colorectal neoplasms, mass screening, sensitivity, specificity

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