Divergent long-term detection rates of proximal and distal advanced neoplasia in fecal immunochemical test screening programs: A retrospective cohort study

Manuel Zorzi, Cesare Hassan, Giulia Capodaglio, Elena Narne, Anna Turrin, Maddalena Baracco, Antonella Dal Cin, Annarita Fiore, Giancarla Martin, Alessandro Repici, Douglas Rex, Massimo Rugge

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Abstract

Background: Short-term studies have reported that the fecal immunochemical test (FIT) is less accurate in detecting proximal than distal colorectal neoplasia. Objective: To assess the long-term detection rates for advanced adenoma and colorectal cancer (CRC), according to anatomical location. Design: Retrospective study. Setting: Population-based, organized screening program in the Veneto region of Italy. Participants: Persons aged 50 to 69 years who completed 6 rounds of FIT screening. Measurements: At each screening round, the detection rates for advanced adenoma and cancer, as well as the proportional interval cancer rate (PICR), were calculated by anatomical location (proximal colon, distal colon, or rectum). Results: Between 2002 and 2014, a total of 123 347 participants had 441 647 FITs. The numbers of advanced adenomas and cancer cases detected, respectively, were 1704 and 200 in the proximal colon, 3703 and 324 in the distal colon, and 1220 and 209 in the rectum. Although the detection rate for proximal colon cancer declined only from the first to the second screening round (0.63 to 0.36 per 1000 screenees), the rate for both distal colon and rectal cancer steadily decreased across 6 rounds (distal colon, 1.65 in the first round to 0.17 in the sixth; rectum, 0.82 in the first round to 0.17 in the sixth). Similar trends were found for advanced adenoma (proximal colon, 5.32 in the first round to 4.22 in the sixth; distal colon, 15.2 in the first round to 5.02 in the sixth). Overall, 150 cases of interval cancer were diagnosed. The PICR was higher in the proximal colon (25.2% [95% CI, 19.9% to 31.5%]) than the distal colon (6.0% [CI, 3.9% to 8.9%]) or rectum (9.9% [CI, 6.9% to 13.7%]). Limitations: Participants with irregular attendance were censored. Those who had a false-positive result on a previous FIT but negative colonoscopy results were included in subsequent rounds. Conclusion: This FIT-based, multiple-round, long-term screening program had a negligible reduction in detection rates for neoplastic lesions in the proximal versus the distal colon after the first round. This was related to a higher PICR in the proximal colon and suboptimal efficacy in preventing the age-related proximal shifting of CRC.

Original languageEnglish (US)
Pages (from-to)602-609
Number of pages8
JournalAnnals of Internal Medicine
Volume169
Issue number9
DOIs
StatePublished - Nov 6 2018

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Colon
Cohort Studies
Retrospective Studies
Neoplasms
Rectum
Adenoma
Colonic Neoplasms
Colorectal Neoplasms
Colonoscopy
Rectal Neoplasms
Italy
Population

ASJC Scopus subject areas

  • Internal Medicine

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Divergent long-term detection rates of proximal and distal advanced neoplasia in fecal immunochemical test screening programs : A retrospective cohort study. / Zorzi, Manuel; Hassan, Cesare; Capodaglio, Giulia; Narne, Elena; Turrin, Anna; Baracco, Maddalena; Dal Cin, Antonella; Fiore, Annarita; Martin, Giancarla; Repici, Alessandro; Rex, Douglas; Rugge, Massimo.

In: Annals of Internal Medicine, Vol. 169, No. 9, 06.11.2018, p. 602-609.

Research output: Contribution to journalArticle

Zorzi, M, Hassan, C, Capodaglio, G, Narne, E, Turrin, A, Baracco, M, Dal Cin, A, Fiore, A, Martin, G, Repici, A, Rex, D & Rugge, M 2018, 'Divergent long-term detection rates of proximal and distal advanced neoplasia in fecal immunochemical test screening programs: A retrospective cohort study', Annals of Internal Medicine, vol. 169, no. 9, pp. 602-609. https://doi.org/10.7326/M18-0855
Zorzi, Manuel ; Hassan, Cesare ; Capodaglio, Giulia ; Narne, Elena ; Turrin, Anna ; Baracco, Maddalena ; Dal Cin, Antonella ; Fiore, Annarita ; Martin, Giancarla ; Repici, Alessandro ; Rex, Douglas ; Rugge, Massimo. / Divergent long-term detection rates of proximal and distal advanced neoplasia in fecal immunochemical test screening programs : A retrospective cohort study. In: Annals of Internal Medicine. 2018 ; Vol. 169, No. 9. pp. 602-609.
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title = "Divergent long-term detection rates of proximal and distal advanced neoplasia in fecal immunochemical test screening programs: A retrospective cohort study",
abstract = "Background: Short-term studies have reported that the fecal immunochemical test (FIT) is less accurate in detecting proximal than distal colorectal neoplasia. Objective: To assess the long-term detection rates for advanced adenoma and colorectal cancer (CRC), according to anatomical location. Design: Retrospective study. Setting: Population-based, organized screening program in the Veneto region of Italy. Participants: Persons aged 50 to 69 years who completed 6 rounds of FIT screening. Measurements: At each screening round, the detection rates for advanced adenoma and cancer, as well as the proportional interval cancer rate (PICR), were calculated by anatomical location (proximal colon, distal colon, or rectum). Results: Between 2002 and 2014, a total of 123 347 participants had 441 647 FITs. The numbers of advanced adenomas and cancer cases detected, respectively, were 1704 and 200 in the proximal colon, 3703 and 324 in the distal colon, and 1220 and 209 in the rectum. Although the detection rate for proximal colon cancer declined only from the first to the second screening round (0.63 to 0.36 per 1000 screenees), the rate for both distal colon and rectal cancer steadily decreased across 6 rounds (distal colon, 1.65 in the first round to 0.17 in the sixth; rectum, 0.82 in the first round to 0.17 in the sixth). Similar trends were found for advanced adenoma (proximal colon, 5.32 in the first round to 4.22 in the sixth; distal colon, 15.2 in the first round to 5.02 in the sixth). Overall, 150 cases of interval cancer were diagnosed. The PICR was higher in the proximal colon (25.2{\%} [95{\%} CI, 19.9{\%} to 31.5{\%}]) than the distal colon (6.0{\%} [CI, 3.9{\%} to 8.9{\%}]) or rectum (9.9{\%} [CI, 6.9{\%} to 13.7{\%}]). Limitations: Participants with irregular attendance were censored. Those who had a false-positive result on a previous FIT but negative colonoscopy results were included in subsequent rounds. Conclusion: This FIT-based, multiple-round, long-term screening program had a negligible reduction in detection rates for neoplastic lesions in the proximal versus the distal colon after the first round. This was related to a higher PICR in the proximal colon and suboptimal efficacy in preventing the age-related proximal shifting of CRC.",
author = "Manuel Zorzi and Cesare Hassan and Giulia Capodaglio and Elena Narne and Anna Turrin and Maddalena Baracco and {Dal Cin}, Antonella and Annarita Fiore and Giancarla Martin and Alessandro Repici and Douglas Rex and Massimo Rugge",
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T1 - Divergent long-term detection rates of proximal and distal advanced neoplasia in fecal immunochemical test screening programs

T2 - A retrospective cohort study

AU - Zorzi, Manuel

AU - Hassan, Cesare

AU - Capodaglio, Giulia

AU - Narne, Elena

AU - Turrin, Anna

AU - Baracco, Maddalena

AU - Dal Cin, Antonella

AU - Fiore, Annarita

AU - Martin, Giancarla

AU - Repici, Alessandro

AU - Rex, Douglas

AU - Rugge, Massimo

PY - 2018/11/6

Y1 - 2018/11/6

N2 - Background: Short-term studies have reported that the fecal immunochemical test (FIT) is less accurate in detecting proximal than distal colorectal neoplasia. Objective: To assess the long-term detection rates for advanced adenoma and colorectal cancer (CRC), according to anatomical location. Design: Retrospective study. Setting: Population-based, organized screening program in the Veneto region of Italy. Participants: Persons aged 50 to 69 years who completed 6 rounds of FIT screening. Measurements: At each screening round, the detection rates for advanced adenoma and cancer, as well as the proportional interval cancer rate (PICR), were calculated by anatomical location (proximal colon, distal colon, or rectum). Results: Between 2002 and 2014, a total of 123 347 participants had 441 647 FITs. The numbers of advanced adenomas and cancer cases detected, respectively, were 1704 and 200 in the proximal colon, 3703 and 324 in the distal colon, and 1220 and 209 in the rectum. Although the detection rate for proximal colon cancer declined only from the first to the second screening round (0.63 to 0.36 per 1000 screenees), the rate for both distal colon and rectal cancer steadily decreased across 6 rounds (distal colon, 1.65 in the first round to 0.17 in the sixth; rectum, 0.82 in the first round to 0.17 in the sixth). Similar trends were found for advanced adenoma (proximal colon, 5.32 in the first round to 4.22 in the sixth; distal colon, 15.2 in the first round to 5.02 in the sixth). Overall, 150 cases of interval cancer were diagnosed. The PICR was higher in the proximal colon (25.2% [95% CI, 19.9% to 31.5%]) than the distal colon (6.0% [CI, 3.9% to 8.9%]) or rectum (9.9% [CI, 6.9% to 13.7%]). Limitations: Participants with irregular attendance were censored. Those who had a false-positive result on a previous FIT but negative colonoscopy results were included in subsequent rounds. Conclusion: This FIT-based, multiple-round, long-term screening program had a negligible reduction in detection rates for neoplastic lesions in the proximal versus the distal colon after the first round. This was related to a higher PICR in the proximal colon and suboptimal efficacy in preventing the age-related proximal shifting of CRC.

AB - Background: Short-term studies have reported that the fecal immunochemical test (FIT) is less accurate in detecting proximal than distal colorectal neoplasia. Objective: To assess the long-term detection rates for advanced adenoma and colorectal cancer (CRC), according to anatomical location. Design: Retrospective study. Setting: Population-based, organized screening program in the Veneto region of Italy. Participants: Persons aged 50 to 69 years who completed 6 rounds of FIT screening. Measurements: At each screening round, the detection rates for advanced adenoma and cancer, as well as the proportional interval cancer rate (PICR), were calculated by anatomical location (proximal colon, distal colon, or rectum). Results: Between 2002 and 2014, a total of 123 347 participants had 441 647 FITs. The numbers of advanced adenomas and cancer cases detected, respectively, were 1704 and 200 in the proximal colon, 3703 and 324 in the distal colon, and 1220 and 209 in the rectum. Although the detection rate for proximal colon cancer declined only from the first to the second screening round (0.63 to 0.36 per 1000 screenees), the rate for both distal colon and rectal cancer steadily decreased across 6 rounds (distal colon, 1.65 in the first round to 0.17 in the sixth; rectum, 0.82 in the first round to 0.17 in the sixth). Similar trends were found for advanced adenoma (proximal colon, 5.32 in the first round to 4.22 in the sixth; distal colon, 15.2 in the first round to 5.02 in the sixth). Overall, 150 cases of interval cancer were diagnosed. The PICR was higher in the proximal colon (25.2% [95% CI, 19.9% to 31.5%]) than the distal colon (6.0% [CI, 3.9% to 8.9%]) or rectum (9.9% [CI, 6.9% to 13.7%]). Limitations: Participants with irregular attendance were censored. Those who had a false-positive result on a previous FIT but negative colonoscopy results were included in subsequent rounds. Conclusion: This FIT-based, multiple-round, long-term screening program had a negligible reduction in detection rates for neoplastic lesions in the proximal versus the distal colon after the first round. This was related to a higher PICR in the proximal colon and suboptimal efficacy in preventing the age-related proximal shifting of CRC.

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