scholarly journals Yield and Efficiency of FIT Tests Alone vs. In Combination with Risk Factors for Colorectal Cancer Screening

2020 ◽  
Vol 3 ◽  
Author(s):  
Vasu Sheel ◽  
Leslie Azzis ◽  
Racehl Hinrichs ◽  
Thomas Imperiale
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Systematic Review ◽  
High Risk ◽  
Colorectal Neoplasia ◽  
Risk Groups ◽  
Fiscal Year ◽  
Advanced Colorectal Neoplasia ◽  
Immunochemical Test ◽  
Advanced Adenomas

Background: Although colonoscopy (CY) may be considered the best screening test for colorectal cancer (CRC), annual fecal immunochemical test (FIT), which quantifies fecal hemoglobin is a viable alternative. Countries and healthcare systems using FIT-based screening may need to prioritize which FIT positive persons requires CY sooner (e.g. within the same fiscal year). We conducted a systematic review of published literature to understand how the yield/positive predictive value (PPV) of FIT could be improved.   Study Design: We performed a search of electronic databases for articles published between 2015 and June 2020. Titles, abstracts, and full texts were independently screened. Included studies fulfilled predetermined criteria and had descriptive and quantitative data extracted. We identified studies comparing the yield of FIT for advanced colorectal neoplasia ([AN], CRC plus advanced adenomas) among FIT positive persons to the yield of AN when FIT is combined with risk factors (age, sex, BMI, etc.). Data were extracted to find yield and efficiency of FIT alone vs FIT plus risk factors among FIT positive persons.   Results: From 623 titles reviewed, 4 studies met inclusion criteria. The objective of the studies was to increase the yield of AN or CRC in FIT positive patients. The number needed to scope (NNS) among FIT positives to detect AN significantly decreased for each study when looking at high risk groups as yield/PPV increased. The yield with FIT alone ranged from 24% to 46% and the NNS from 2.2 to 4.1. With risk factors, yield and NNS among those at high risk were 33.2 % to 75.6% and from 1.3 to 3.0, respectively.  Conclusion and Potential Impact: This systematic review quantifies how risk factors improve the yield for AN in FIT positive persons, which is information required for countries and health care settings with limited resources that need to direct CY resources to FIT positive patients at high risk for AN.  

scholarly journals Prevalence of HIV in Different High-Risk Groups and Associated Risk Factors in Pakistan. A Systematic Review from 2010 to 2020

2021 ◽  
Vol 04 (03) ◽  
Author(s):  
Aswa Gondal ◽  
Mahrukh Rasheed ◽  
Sana Ali ◽  
Zain Ul Abdin ◽  
Omar Rahim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
High Risk ◽  
Risk Groups ◽  
Associated Risk Factors

scholarly journals Tuberculosis screening costs and cost-effectiveness in high-risk groups: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
H. Alsdurf ◽  
B. Empringham ◽  
C. Miller ◽  
A. Zwerling
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
High Risk ◽  
Cost Effective ◽  
Risk Groups ◽  
Screening Tools ◽  
Molecular Diagnostic ◽  
Systematic Screening ◽  
Structural Risk

Abstract Background Systematic screening for active tuberculosis (TB) is a strategy which requires the health system to seek out individuals, rather than waiting for individuals to self-present with symptoms (i.e., passive case finding). Our review aimed to summarize the current economic evidence and understand the costs and cost-effectiveness of systematic screening approaches among high-risk groups and settings. Methods We conducted a systematic review on economic evaluations of screening for TB disease targeting persons with clinical and/or structural risk factors, such as persons living with HIV (PLHIV) or persons experiencing homelessness. We searched three databases for studies published between January 1, 2010 and February 1, 2020. Studies were included if they reported cost and a key outcome measure. Owing to considerable heterogeneity in settings and type of screening strategy, we synthesized data descriptively. Results A total of 27 articles were included in our review; 19/27 (70%) took place in high TB burden countries. Seventeen studies took place among persons with clinical risk factors, including 14 among PLHIV, while 13 studies were among persons with structural risk factors. Nine studies reported incremental cost-effectiveness ratios (ICERs) ranging from US$51 to $1980 per disability-adjusted life year (DALY) averted. Screening was most cost-effective among PLHIV. Among persons with clinical and structural risk factors there was limited evidence, but screening was generally not shown to be cost-effective. Conclusions Studies showed that screening is most likely to be cost-effective in a high TB prevalence population. Our review highlights that to reach the “missing millions” TB programmes should focus on simple, cheaper initial screening tools (i.e., symptom screen and CXR) followed by molecular diagnostic tools (i.e., Xpert®) among the highest risk groups in the local setting (i.e., PLHIV, urban slums). Programmatic costs greatly impact cost-effectiveness thus future research should provide both fixed and variable costs of screening interventions to improve comparability.

Derivation and validation of a predictive model for advanced colorectal neoplasia in asymptomatic adults

Gut ◽  
2020 ◽  
pp. gutjnl-2020-321698
Author(s):  
Thomas F Imperiale ◽  
Patrick O Monahan ◽  
Timothy E Stump ◽  
David F Ransohoff
Keyword(s):  
High Risk ◽  
Colorectal Neoplasia ◽  
Risk Groups ◽  
Low Risk ◽  
Screening Tests ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Intermediate Risk ◽  
C Statistic ◽  
Advanced Colorectal Neoplasia

ObjectiveKnowing risk for advanced colorectal neoplasia (AN) could help patients and providers choose among screening tests, improving screening efficiency and uptake. We created a risk prediction model for AN to help decide which test might be preferred, a use not considered for existing models.DesignAverage-risk 50-to-80-year olds undergoing first-time screening colonoscopy were recruited from endoscopy units in Indiana. We measured sociodemographic and physical features, medical and family history and lifestyle factors and linked these to the most advanced finding. We derived a risk equation on two-thirds of the sample and assigned points to each variable to create a risk score. Scores with comparable risks were collapsed into risk categories. The model and score were tested on the remaining sample.ResultsAmong 3025 subjects in the derivation set (mean age 57.3 (6.5) years; 52% women), AN prevalence was 9.4%. The 13-variable model (c-statistic=0.77) produced three risk groups with AN risks of 1.5% (95% CI 0.72% to 2.74%), 7.06% (CI 5.89% to 8.38%) and 27.26% (CI 23.47% to 31.30%) in low-risk, intermediate-risk and high-risk groups (p value <0.001), containing 23%, 59% and 18% of subjects, respectively. In the validation set of 1475 subjects (AN prevalence of 8.4%), model performance was comparable (c-statistic=0.78), with AN risks of 2.73% (CI 1.25% to 5.11%), 5.57% (CI 4.12% to 7.34%) and 25.79% (CI 20.51% to 31.66%) in low-risk, intermediate-risk and high-risk subgroups, respectively (p<0.001), containing proportions of 23%, 59% and 18%.ConclusionAmong average-risk persons, this model estimates AN risk with high discrimination, identifying a lower risk subgroup that may be screened non-invasively and a higher risk subgroup for which colonoscopy may be preferred. The model could help guide patient–provider discussions of screening options, may increase screening adherence and conserve colonoscopy resources.

Prevalence of advanced colorectal neoplasia according to risk categories at screening colonoscopy in a tertiary referral center.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 578-578
Author(s):  
Eduardo Negrete Carballo ◽  
Fidel David Huitzil Melendez
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Colorectal Neoplasia ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Moderate Risk ◽  
Advanced Colorectal Neoplasia ◽  
Advanced Neoplasm ◽  
Colorectal Screening

578 Background: Colorectal cancer (CRC) is the third most common cancer in the world. There is strong evidence that screening for colorectal cancer improves survival in conutries with high incidence. Although Mexico is considered a country with a low incidence of CRC, 4694 potentially preventable deaths occur every year. There is no established CRC screening program in our country, risk stratification of the target populations to be screened may bring potential advantages, making the strategy more cost-effective. The Asia-Pacific Colorectal Screening (APCS) score, is a validated risk-stratification tool that helps identify individuals at risk for advanced colorectal neoplasm amongst the asymptomatic population. Methods: We performed a retrospective, cross-sectional analysis of database records from 1172 patients who underwent screening colonoscopy betwen january 2013 and november 2014. Results: The prevalence of advanced colorectal neoplasia was 2.9%. Applying the APCS stratification, 91 subjects (7.8%) were in the average risk tier, 849 subjects (72.4%) in the moderate risk tier and 232 (19.8%) subjects in the high risk tier. The prevalence of advanced neoplasia in the average risk, moderate risk and high risk groups was 0%, 2.6% and 5.1%, respectively. The subjects in the high risk tier had 2.21-fold (p = 0.021) increased prevalence of advanced neoplasia than those in the average-moderate tier. Conclusions: The APCS score is a simple risk stratification index for colorectal advanced neoplasm that uses elementary clinical information on age, gender, family history and smoking to stratify the risk of colorectal advanced neoplasm in asymptomatic subjects for priority of colorectal screening.

scholarly journals Comparative Effectiveness of Fecal Immunochemical Tests versus Flexible Sigmoidoscopy for Colorectal Cancer Screening: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

2021 ◽  
Author(s):  
Hemant Mutneja ◽  
Rohit Agrawal ◽  
Abhishek Bhurwal ◽  
Shilpa Arora ◽  
Andrew Go ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Flexible Sigmoidoscopy ◽  
Colorectal Neoplasia ◽  
Meta Analysis ◽  
Detection Rates ◽  
Crc Screening ◽  
Advanced Colorectal Neoplasia

Background and Aims: Fecal immunochemical tests (FITs) and flexible sigmoidoscopies are commonly used modalities for colorectal cancer (CRC) screening. We performed a systematic review and meta-analysis to compare the effectiveness of FIT and sigmoidoscopy in CRC screening. Methods: PRISMA statement and Cochrane guidelines were followed for this review. Digital dissertation databases were searched from inception till December 1st 2020 and randomized clinical trials comparing the detection rates of CRC for FIT and sigmoidoscopy were included. Outcomes for analysis included participation rates and detection rates of CRC, advanced adenomas and advanced colorectal neoplasia for both screening modalities. Results: Five randomized clinical trials with a total of 261,755 patients were included for the analysis. The participation rate for FIT was significantly higher compared to flexible sigmoidoscopy (OR 2.11, 95% CI 1.29-3.44, p=0.003). In intention-to-screen analysis, the detection rate for advanced colorectal neoplasia was significantly lower with FIT (OR 0.62, 95% CI 0.45-0.84, p=0.002) as compared to flexible sigmoidoscopy but not statistically different for CRC (OR 1.15, 95% CI 0.65-2.02, p=0.63). Conclusion: Despite lower participation amongst patients, CRC screening with flexible sigmoidoscopy leads to higher detection of advanced colorectal neoplasia, when compared to a single round of fecal immunochemical testing.

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