Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

Rocío Aznar-Gimeno; Patricia Carrera-Lasfuentes; Rafael Del-Hoyo-Alonso; Manuel Doblaré; Ángel Lanas

doi:10.3389/fmed.2021.712040

Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

Front Med (Lausanne). 2021 Jul 27:8:712040. doi: 10.3389/fmed.2021.712040. eCollection 2021.

Authors

Rocío Aznar-Gimeno¹, Patricia Carrera-Lasfuentes^{2

3}, Rafael Del-Hoyo-Alonso¹, Manuel Doblaré^{3

4

5

6}, Ángel Lanas^{2

3

7

8}

Affiliations

¹ Department of Big Data and Cognitive Systems, Instituto Tecnológico de Aragón, ITAINNOVA, Zaragoza, Spain.
² Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain.
³ Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain.
⁴ Aragón Institute of Engineering Research (I3A), Zaragoza, Spain.
⁵ Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain.
⁶ Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBERbbn), Madrid, Spain.
⁷ Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.
⁸ Service of Digestive Diseases, University Clinic Hospital, Zaragoza, Spain.

Abstract

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-μg 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.

Keywords: adenomas; colonoscopy; colorectal cancer; decision-making; screening fecal-immunological test.