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      The effectiveness of FOBT vs. FIT: A meta-analysis on colorectal cancer screening test

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          Abstract

          Background: After lung and prostate cancers, colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women after breast cancer worldwide. Every year, more than one million people are diagnosed with colorectal cancer worldwide and half of these patients die from this disease, making it the fourth leading cause of death in the world. This systematic review aimed to assess the effectiveness of the two colorectal diagnostic tests of FOBT (fecal occult blood test) and FIT (fecal immunochemical test)) in terms of technical performance.

          Methods: To retrieve the relevant evidence, appropriate medical databases such as Cochrane library, NHSEED, Scopus and Google scholar were searched from February 2013 to July 2014, using free-texts and Mesh. In this study, inclusion/exclusion criteria of the papers, randomized controlled trials, economic evaluations, systematic reviews, meta-analyses and meta-syntheses of the effectiveness of FIT versus FOBT tests in moderate-risk populations (age: 50 to 70 years), which had reported the least of such outcomes as sensitivity, specificity and clinical outcomes were reviewed. The analyses of the effectiveness outcomes were performed in the form of meta-analysis.

          Results: Five papers were eligible to be included in the final phase of the study for synthesis. FIT showed a better performance in participation and positivity rate. Moreover, in terms of false positive and negative rate, FIT showed fewer rates compared to FOBT (RR:-4.06; 95% CI (-7.89-0.24), and NN-scope (Number need to scope) (2.2% vs. 1.6%), and NN-screen (Number need to screen) (84% vs. 31-49% in different cut off levels) showed significant differences in FOBT vs. FIT, respectively.

          Conclusion: In the five included studies (3, 11-14), the acceptability of FIT was more than FOBT. However, in our meta-analysis, no difference was found between the two tests. FIT was significant in positivity rate and had a better performance in participation rate, and a fewer false negative numbers compared to FOBT.

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          Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population.

          Leo van Rossum, Anne F. van Rijn, Robert Laheij … (2008)
          Despite poor performance, guaiac-based fecal occult blood tests (G-FOBT) are most frequently implemented for colorectal cancer screening. Immunochemical fecal occult blood tests (I-FOBT) are claimed to perform better, without randomized comparison in screening populations. Our aim was to randomly compare G-FOBT with I-FOBT in a screening population. We conducted a population-based study on a random sample of 20,623 individuals 50-75 years of age, randomized to either G-FOBT (Hemoccult-II) or I-FOBT (OC-Sensor). Tests and invitations were sent together. For I-FOBT, the standard cutoff of 100 ng/ml was used. Positive FOBTs were verified with colonoscopy. Advanced adenomas were defined as >or=10 mm, high-grade dysplasia, or >or=20% villous component. There were 10,993 tests returned: 4836 (46.9%) G-FOBTs and 6157 (59.6%) I-FOBTs. The participation rate difference was 12.7% (P < .01). Of G-FOBTs, 117 (2.4%) were positive versus 339 (5.5%) of I-FOBTs. The positivity rate difference was 3.1% (P < .01). Cancer and advanced adenomas were found, respectively, in 11 and 48 of G-FOBTs and in 24 and 121 of I-FOBTs. Differences in positive predictive value for cancer and advanced adenomas and cancer were, respectively, 2.1% (P = .4) and -3.6% (P = .5). Differences in specificities favor G-FOBT and were, respectively, 2.3% (P < .01) and -1.3% (P < .01). Differences in intention-to-screen detection rates favor I-FOBT and were, respectively, 0.1% (P < .05) and 0.9% (P < .01). The number-to-scope to find 1 cancer was comparable between the tests. However, participation and detection rates for advanced adenomas and cancer were significantly higher for I-FOBT. G-FOBT significantly underestimates the prevalence of advanced adenomas and cancer in the screening population compared with I-FOBT.
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            A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population.

            Tamiya Morikawa, Jun Kato, Yutaka Yamaji … (2005)
            The fecal occult blood test (FOBT) is recommended as a screening test for colorectal cancer, but there are few reliable studies on the accuracy of immunochemical FOBT. The aim of this study was to analyze the sensitivity of immunochemical FOBT and to compare the results with the findings from complete colonoscopy. Asymptomatic adults underwent 1-time immunochemical FOBT and total colonoscopy simultaneously. The prevalence and location of colorectal neoplasia were determined by colonoscopy. The results of immunochemical FOBT and the colonoscopic findings were compared. Of 21,805 patients, immunochemical FOBT was positive in 1231 cases (5.6%). The sensitivity of 1-time immunochemical FOBT for detecting advanced neoplasia and invasive cancer was 27.1% and 65.8%, respectively. In addition, the sensitivity for invasive cancer according to Dukes' stage showed 50.0% for Dukes' stage A, 70.0% for Dukes' stage B, and 78.3% for Dukes' stages C or D. The sensitivity for detecting advanced neoplasia at the proximal colon was significantly lower than that detected in the distal colon (16.3% vs 30.7%, P = .00007). Although the screening of asymptomatic patients with immunochemical FOBT can identify patients with colorectal neoplasia to a certain extent, the sensitivity is relatively low and different according to the tumor location. Therefore, programmatic and repeated screening by immunochemical FOBT may be necessary to increase sensitivity for colorectal cancer detection.
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              Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force.

              Ann G Zauber, Iris Lansdorp-Vogelaar, Amy B Knudsen … (2008)
              The U.S. Preventive Services Task Force requested a decision analysis to inform their update of recommendations for colorectal cancer screening. To assess life-years gained and colonoscopy requirements for colorectal cancer screening strategies and identify a set of recommendable screening strategies. Decision analysis using 2 colorectal cancer microsimulation models from the Cancer Intervention and Surveillance Modeling Network. Derived from the literature. U.S. average-risk 40-year-old population. Societal. Lifetime. Fecal occult blood tests (FOBTs), flexible sigmoidoscopy, or colonoscopy screening beginning at age 40, 50, or 60 years and stopping at age 75 or 85 years, with screening intervals of 1, 2, or 3 years for FOBT and 5, 10, or 20 years for sigmoidoscopy and colonoscopy. Number of life-years gained compared with no screening and number of colonoscopies and noncolonoscopy tests required. Beginning screening at age 50 years was consistently better than at age 60. Decreasing the stop age from 85 to 75 years decreased life-years gained by 1% to 4%, whereas colonoscopy use decreased by 4% to 15%. Assuming equally high adherence, 4 strategies provided similar life-years gained: colonoscopy every 10 years, annual Hemoccult SENSA (Beckman Coulter, Fullerton, California) testing or fecal immunochemical testing, and sigmoidoscopy every 5 years with midinterval Hemoccult SENSA testing. Annual Hemoccult II and flexible sigmoidoscopy every 5 years alone were less effective. The results were most sensitive to beginning screening at age 40 years. The stop age for screening was based only on chronologic age. The findings support colorectal cancer screening with the following: colonoscopy every 10 years, annual screening with a sensitive FOBT, or flexible sigmoidoscopy every 5 years with a midinterval sensitive FOBT from age 50 to 75 years.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med J Islam Repub Iran
                Journal ID (iso-abbrev): Med J Islam Repub Iran
                Journal ID (publisher-id): MJIRI
                Journal ID (publisher-id): Med J Islam Repub Iran
                Title: Medical Journal of the Islamic Republic of Iran
                Publisher: Iran University of Medical Sciences
                ISSN (Print): 1016-1430
                ISSN (Electronic): 2251-6840
                Publication date Collection: 2016
                Publication date (Electronic): 09 May 2016
                Volume: 30
                Page: 366
                Affiliations
                1 BPH, MSc, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. mousavimary61964@ 123456gmail.com
                2 DVM, MSc, PhD, Professor, School of Public Health and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. rezamajd@ 123456tums.ac.ir
                3 MD, PhD, Associate Professor, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. akbarisari@ 123456tums.ac.ir
                4 MD, MPH, Associate Professor, Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran. delavari@ 123456tums.ac.ir
                5 BSNtr, MSc, Knowledge Utilization Research Centre (KURC), Tehran University of Medical Sciences, Tehran, Iran. f-mohtasham@ 123456farabi.tums.ac.ir
                Author notes
                (Corresponding author) DVM, MSc, PhD, Professor, School of Public Health and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. rezamajd@ 123456tums.ac.ir
                Article
                PMC ID: 4972062
                PubMed ID: 27493910
                SO-VID: 606ada1b-710d-48a9-b064-d434b91fc3a4
                Copyright © © 2016 Iran University of Medical Sciences
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0), which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                Date received : 18 September 2015
                Date accepted : 16 November 2015
                Page count
                Figures: 1, Tables: 1, References: 73, Pages: 14
                Categories
                Subject: Original Article

                Keywords: neoplasm,fobt,fit
                Data availability:
                Keywords: neoplasm, fobt, fit

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