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Clinical Studies

Significant decrease in interval colorectal cancer incidence after implementing immunochemical testing in a multiple-round guaiac-based screening programme

Abstract

Background and aims

We aimed to evaluate the effects of switching to faecal immunochemical testing (FIT) on the cumulative 2-year incidence rate of interval cancers, interval cancer rate and test sensitivity within a mature population-based colorectal cancer screening programme consisting of six rounds of biennial guaiac faecal occult blood testing (gFOBT).

Methods

The FIT results were compared with those of gFOBT used in each of the previous two rounds. For the three rounds analysed, 279,041 tests were performed by 156,186 individuals. Logistic regression analysis was used to determine interval cancer risk factors (Poisson regression) and to compare the sensitivity of FIT to gFOBT.

Results

There were 612 cases of screen-detected cancers and 209 cases of interval cancers. The sex- and age-adjusted cumulative 2-year incidence rates of interval cancers were 55.7 (95% CI, 45.3–68.5), 42.4 (95% CI, 32.6–55.2) and 15.8 (95% CI, 10.9–22.8) per 100,000 person-years after the last two rounds of gFOBT and FIT, respectively. The FIT/gFOBT incidence rate ratio was 0.38 [95% CI, 0.27–0.54] (P < 0.001). Sex- and age-adjusted sensitivity was significantly higher with FIT than with gFOBT (OR = 6.70 [95% CI, 4.48–10.01], P < 0.0001).

Conclusions

This population-based study revealed a dramatic decrease in the cumulative incidence rates of interval cancers after switching from gFOBT to FIT. These data provide an additional incentive for countries still using gFOBT to switch to FIT.

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Data availability

The authors state that the data from their study are available on request from the Biostatistics Department of the University Hospital Center of Rennes (chloe.rousseau@chu-rennes.fr).

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Acknowledgements

The authors acknowledge the contributions of the general practitioners, gastroenterologists and surgeons in the district of Ille-et-Vilaine. They also acknowledge the staff in charge of the database at the screening centre, particularly Samuel Foucrit, a computer scientist.

Funding

The authors received no specific funding for this work.

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Affiliations

Authors

Contributions

Conception and design (JFB, CP, MC and AL); analysis and interpretation of the data (CR, JFB, AL, AC, CP and MC) and drafting of the article (JFB and AL); all of the authors approved the final manuscript.

Corresponding author

Correspondence to Jean-François Bretagne.

Ethics declarations

Ethics approval and consent to participate

The colorectal cancer screening programme was declared and approved by the CNIL (Commission Nationale de l’Informatique et des Libertés) on August 30, 2002 (no. 812571). This research was approved by the CCTIRS (Comité Consultatif pour le Traitement de l’Information en Matière de Recherche dans le Domaine de la Santé).

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Not applicable.

Competing interests

The authors declare no competing interests.

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Bretagne, JF., Carlo, A., Piette, C. et al. Significant decrease in interval colorectal cancer incidence after implementing immunochemical testing in a multiple-round guaiac-based screening programme. Br J Cancer (2021). https://doi.org/10.1038/s41416-021-01546-z

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