Atija Kapidzic

Attendance and Yield Over Three Rounds of Population-Based Fecal Immunochemical Test Screening

OBJECTIVES:Fecal immunochemical test (FIT) screening for colorectal cancer (CRC) requires timely successive rounds for an optimal preventive effect. However, data on attendance and trend in yield over multiple rounds of FIT screening are limited. We therefore conducted a consecutive third round of FIT screening in a population-based CRC screening trial.METHODS:Average-risk subjects aged 50–74 years were approached for three rounds of 1-sample FIT (OC-sensor) screening. Subjects with a hemoglobin level ≥50 ng/ml (≥10 μg Hb/g) feces were referred for colonoscopy. Subjects with a positive FIT in previous rounds were not re-invited for FIT screening.RESULTS:In the first round, 7,501 subjects were invited. The participation rate was 62.6% in the first round, 63.2% in the second round, and 68.3% in the third round (P<0.001). In total, 73% (5,241/7,229) of all eligible subjects participated in at least one of three rounds. The positivity rate was significantly higher in the first (8.4%) round compared with the second (6.0%) and third (5.7%) screening rounds (P<0.001). The detection rate of advanced neoplasia (AN) declined from the first round to subsequent rounds (round 1: 3.3%; round 2: 1.9%; and round 3: 1.3%; P<0.001). The positive predictive value for AN was 40.7% in the first screening round, 33.2% in the second screening round, and 24.0% in the third screening round (P<0.001).CONCLUSIONS:Repeated biennial FIT screening is acceptable with increased participation in successive screening rounds, and >70% of all eligible subjects participating at least once over three rounds. The decline in screen-detected AN over three screening rounds is compatible with a decreased prevalence of AN as a result of repeated FIT screening. These findings provide strong evidence for the effectiveness of FIT screening and stress the importance of ongoing research over multiple screening rounds.

Second-look colonoscopies and the impact on capacity in FIT-based colorectal cancer screening

Objectives:Fecal immunochemical testing (FIT) and colonoscopy are tandem procedures in colorectal cancer (CRC) screening. A positive FIT predicts advanced neoplasia (AN) that requires endoscopic detection and removal. En bloc or piecemeal resection of AN is associated with a significant rate of residual or recurrent neoplasia. Second-look colonoscopies are indicated to assess completeness of removal of AN. These colonoscopies can make a substantial demand on colonoscopy capacity and health-care system. This study is the first to evaluate the demand and risk factors for second-look colonoscopy in FIT CRC screening.Methods:All colonoscopies after a positive FIT, in subjects aged 50–74 years approached for 3 rounds of FIT screening, were prospectively registered. Second-look colonoscopies were defined as any colonoscopy within 1 year following a colonoscopy after positive FIT.Results:Out of 1,215 FIT-positive screenees undergoing colonoscopy, 105 (8.6%) patients underwent a second-look colonoscopy, of whom 30 (2.5%) underwent more than one colonoscopy (range 2–9), leading to a total of 149 (12.3%) additional colonoscopies. Main reasons for second-look colonoscopies were assessment of complete AN removal (41.9%) and need for additional polypectomy (34.3%). Risk factors were advanced adenomas and poor bowel preparation (P<0.001). High fecal hemoglobin concentration was the only predictor of a second-look colonoscopy before index colonoscopy (P<0.001).Conclusions:Second-look colonoscopies have substantial impact on colonoscopy resources, increasing the demand with 12%. The main reasons for these second-look colonoscopies were previous incomplete polypectomy and control of completeness of removal of neoplastic lesions. A high fecal hemoglobin concentration as measured by FIT can help to identify patients at risk of a second-look colonoscopy.

Mo1984 Third Round of Two-Sample Immunochemical Fecal Occult Blood Test Screening in the Netherlands

Preparation Scale (BBPS) and categorized as either excellent vs. not excellent (BBPS≥7 vs. BBPS<7) or adequate vs. inadequate (BBPS≥5 vs. BBPS<5). There was no change in attending endoscopy staff during the study period. A multivariate logistic regression analysis to identify factors independently associated with excellent bowel preparation was performed. Results Bowel preparation quality was excellent in 40% of patients and adequate in 90%. There was no seasonal variation for adequate bowel preparation. However, there was a significant increase in excellent bowel preparation in the spring and summer compared to autumn and winter (Table 1). A similar trend of increased rate of excellent bowel preparation was observed in the subgroup of patients using split dose bowel preparation (Table 2). Independent factors for excellent bowel preparation were spring and summer scheduling (OR, 1.8; 95% CI 1.52.2; p<0.0008), split bowel preparation (OR, 1.6; 95% CI, 1.2-2.1; p=0.002) and use of narcotics (OR, 0.7; 95%CI, 0.6-0.9; P= 0.003). Conclusions Spring and summer scheduled colonoscopies are associated with greater likelihood of achieving excellent bowel preparation. Seasonal variations in patients eating behavior, fluid consumption, exercise and circadian rhythm could alter colonic transit and hence, quality of bowel preparation for colonoscopy. Table 1

Su1212 Increase in Participation Rate With Successive Rounds of FIT Screening

Multivariable logistic regression was used to determine independent predictors of FOBT receipt. Results: The sample consisted of 115,414 individuals who underwent one or more CRC screening test, including 28,713 who had FOBT. African Americans (multivariate OR 0.84 95 % CI 0.810.88), Hispanics (OR 0.64 95 % CI 0.560.73) and Native American (OR: 0.61 95% CI 0.49 0.76) were less likely to undergo FOBT compared to Caucasians. There was no significant difference across gender in receiving FOBT. There were significantly lower odds of receiving FOBT for patients with Charlson comorbidity scores of higher index of 2 or higher compared to 0 (OR 0.83 95 % CI 0.800.85). An incremental association of small area measures of education, income, and GI density was observed across quartiles, with higher rates seen in areas with greater educational level, median income and GI density. Differences were not observed with HRRmeasures of primary care. There was also geographic variation, with significantly lower odds of FOBT receipt in Midwest (OR 0.58 95 % CI 0.550.60), south (OR 0.90 95 % CI 0.870.94), and west (OR 0.72 95 % CI 0.690.75) compared to northeast. Conclusion: Under Medicare coverage, consistent with other screening tests, there are disparities in the use of FOBT observed across race, educational level, comorbidity, income and geographic region. Further studies should better define the underlying reasons for these disparities.