Challenges and approaches to measuring repeat fecal immunochemical test for colorectal cancer screening
Menée aux Etats-Unis à partir de données portant sur 18 257 personnes âgées de 50 à 60 ans et invitées en 2010 à participer à un programme de dépistage du cancer colorectal comportant un test immunochimique de recherche de sang occulte dans les selles (FIT), cette étude compare, en fonction du type de mesures utilisé, les résultats concernant la répétition des tests FIT sur une période couvrant quatre sessions de dépistage
Background: Colorectal cancer (CRC) screening with fecal immunochemical testing (FIT) can reduce CRC mortality. Effectiveness of FIT may be compromised when patients do not adhere to a regular schedule. However, having no standard measure of repeat FIT presents challenges for assessing effectiveness across populations and settings. We compared three measures of repeat FIT in a large, integrated healthcare system in Dallas, TX.
Methods: We identified 18,257 patients age-eligible (50-60 years) for FIT in January 1 - December 31, 2010 and followed over four rounds of screening. Measures included: 1) repeat FIT in prior screeners, or completing FIT within 9-15 months of the previous; 2); Yes-No patterns, whereby patients were assigned yes or no in 9-15 month windows; and 3) proportion of time covered, or the amount of time patients were up-to-date with screening relative to time eligible.
Results: Repeat FIT varied by measure. Using a prior screeners measure, 15.8% of patients with a normal FIT in Round 1 completed repeat FIT in Round 2. Repeat FIT was notably higher (52.3%) using. The most common Yes-No pattern was YNNN or "one-and-done" and only 9.4% of patients completed two consecutive FITs across all rounds (YYNN).
Conclusions: Different measures of repeat FIT yielded a range of estimates, making comparison across studies difficult. Researchers should weigh the advantages and disadvantages of each measure and select the most appropriate to their research question.
Impact: Our study highlights the need for future research of repeat FIT measures that best approximate screening effectiveness.
Cancer Epidemiology Biomarkers & Prevention , résumé, 2019