Evidence-based selection on the appropriate FIT cut-off point in CRC screening programs in the COVID pandemic

Aznar-Gimeno, R. ; Carrera-Lasfuentes, P. ; del-Hoyo-Alonso, R. ; Doblare, M. (Universidad de Zaragoza) ; Lanas, A. (Universidad de Zaragoza)

Resumen: Background: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs. Resuming these programs is a priority, but fewer colonoscopies may be available. We developed an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC. Methods: We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/2018. We investigated two different scenarios: not modifying vs. modifying the FIT cut-off value. We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed). Results: The current FIT cut-off (20-mu g hemoglobin/g feces) led to 6, 606 colonoscopies per 100, 000 people invited annually. Without modifying this FIT cut-off value, when the optimal number of individuals invited for colonoscopies was reduced by 10-40%, a high number of CRCs and high-risk adenomas (34-135 and 73-288/100.000-people invited, respectively) will be undetected every year. When the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability, the number of missed lesions per year was remarkably reduced (9-36 and 29-145/100.000 people, respectively). Moreover, the unmodified FIT scenario outcome was improved by prioritizing the selection process based on sex (males) and age, rather than randomly reducing the number invited. Conclusions: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors to prioritize access to colonoscopies should be also considered.

Idioma: Inglés

DOI: 10.3389/fmed.2021.712040

Año: 2021

Publicado en: Frontiers in Medicine 8 (2021), 712040 [10 pp.]
ISSN: 2296-858X

Factor impacto JCR: 5.058 (2021)

Categ. JCR: MEDICINE, GENERAL & INTERNAL rank: 53 / 172 = 0.308 (2021) - Q2 - T1

Factor impacto CITESCORE: 3.4 - Medicine (Q2)

Factor impacto SCIMAGO: 1.179 - Medicine (miscellaneous) (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
Área (Departamento): Área Mec.Med.Cont. y Teor.Est. (Dpto. Ingeniería Mecánica)