Varying fecal immunochemical test screening cut-offs by age and gender: a way to increase detection rates and reduce the number of colonoscopies

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BACKGROUND AND AIMS: Most colorectal cancer screening programs based on the fecal immunochemical test use the same cut-off value for all participants. This study aimed at finding age and gender specific cut-off values that can improve population-based colorectal cancer screening.

METHODS: This observational study used data from the first 2 years of the Danish Fecal immunochemical test based colorectal cancer screening program to estimate sensitivity, specificity, number of positive tests, number of screen-detected cancers and adenomas as well as number of interval cancers for various cut-off values for different male and female age groups.

RESULTS: Data from 531,828 participants showed that lower cut-off values for older residents and higher cut-off values for younger residents increased the overall sensitivity and specificity, decreased number of needed colonoscopies by 7%, increased number of screen-detected cancer by 1.1%, increased number of screen-detected adenomas by 5% and decreased number of interval cancers by approximately 1.5%. However, these cut-off values also increased the inequality in sensitivity and specificity. Choosing cut-off values that ensured equal sensitivity between the groups did however increase inequality in, eg, the interval cancer rate.

CONCLUSION: In a fecal immunochemical test based colorectal cancer screening program it is possible to decrease the number of needed colonoscopies while at the same time increase overall sensitivity and specificity and detect more cancers and adenomas, by using different cut-off values for different male and female age groups. However, this will increase inequality in sensitivity and specificity, whereas other strategies like ensuring equal sensitivity could be considered.

Original languageEnglish
JournalGastrointestinal Endoscopy
Pages (from-to)540-549
Number of pages10
Publication statusPublished - Mar 2022

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