Performance of the Fecal Immunochemical Test in Detecting Advanced Colorectal Neoplasms and Colorectal Cancers in People Aged 40-49 Years: A Systematic Review and Meta-Analysis

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2023 Jun 10

PMID 37296969

Authors

Jen-Hao Yeh

Cheng-Hao Tseng

Wen-Lun Wang

Chih-I Chen

Yu-Peng Liu

Yi-Chia Lee

Jaw-Yuan Wang

Yu-Ching Lin

Affiliations

Soon will be listed here.

Abstract

Background: The incidence of early-onset colorectal cancer (CRC) is increasing. Many guidelines recommend initiating screening at 45 years. This study investigated the detection rate of advanced colorectal neoplasm (ACRN) by using fecal immunochemical tests (FITs) in individuals aged 40-49 years.

Methods: PubMed, Embase, and Cochrane Library databases were searched from inception to May 2022. The primary outcomes were the detection rates and positive predictive values of FITs for ACRN and CRC in people aged 40-49 (younger age group) and ≥50 years (average risk group).

Results: Ten studies with 664,159 FITs were included. The FIT positivity rate was 4.9% and 7.3% for the younger age and average risk groups, respectively. Younger individuals with positive FIT results had significantly higher risks of ACRN (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.79-3.73) or CRC (OR 2.86, 95% CI 1.59-5.13) than did individuals in the average-risk group, regardless of FIT results. Individuals aged 45-49 years with positive FIT results had a similar risk of ACRN (OR 0.80, 95% CI 0.49-1.29) to that of people aged 50-59 years with positive FIT results, although significant heterogeneity was observed. The positive predictive values of the FIT were 10-28.1% for ACRN and 2.7-6.8% for CRC in the younger age group.

Conclusion: The detection rate of ACRN and CRC based on FITs in individuals aged 40-49 years is acceptable, and the yield of ACRN might be similar between individuals aged 45-49 and 50-59 years. Further prospective cohort and cost-effective analysis are warranted.

Citing Articles

A decade-long study on pathological distinctions of resectable early versus late onset colorectal cancer and optimal screening age determination.

Song J, Han T, Qian L, Zhu J, Qiao Y, Liu S Sci Rep. 2024; 14(1):27335.

PMID: 39521798 PMC: 11550830. DOI: 10.1038/s41598-024-76951-4.

Early-onset gastrointestinal cancer: An epidemiological reality with great significance and implications.

Triantafillidis J, Georgiou K, Konstadoulakis M, Papalois A World J Gastrointest Oncol. 2024; 16(3):583-597.

PMID: 38577465 PMC: 10989383. DOI: 10.4251/wjgo.v16.i3.583.

References

Siegel R, Medhanie G, Fedewa S, Jemal A . State Variation in Early-Onset Colorectal Cancer in the United States, 1995-2015. J Natl Cancer Inst. 2019; 111(10):1104-1106. PMC: 6792093. DOI: 10.1093/jnci/djz098. View

Yeh J, Lin C, Wang W, Lee C, Chen J, Hsu C . Positive Fecal Immunochemical Test Strongly Predicts Adenomas in Younger Adults With Fatty Liver and Metabolic Syndrome. Clin Transl Gastroenterol. 2021; 12(2):e00305. PMC: 7861879. DOI: 10.14309/ctg.0000000000000305. View

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Butterly L, Siegel R, Fedewa S, Robinson C, Jemal A, Anderson J . Colonoscopy Outcomes in Average-Risk Screening Equivalent Young Adults: Data From the New Hampshire Colonoscopy Registry. Am J Gastroenterol. 2020; 116(1):171-179. DOI: 10.14309/ajg.0000000000000820. View

Jung Y, Park C, Kim N, Park J, Park D, Sohn C . Colorectal cancer screening with the fecal immunochemical test in persons aged 30 to 49 years: focusing on the age for commencing screening. Gastrointest Endosc. 2017; 86(5):892-899. DOI: 10.1016/j.gie.2017.03.1531. View

Guo F, Chen C, Holleczek B, Schottker B, Hoffmeister M, Brenner H . Strong Reduction of Colorectal Cancer Incidence and Mortality After Screening Colonoscopy: Prospective Cohort Study From Germany. Am J Gastroenterol. 2021; 116(5):967-975. DOI: 10.14309/ajg.0000000000001146. View

Nakama H, Zhang B, Zhang X, Fukazawa K . Age-related cancer detection rate and costs for one cancer detected in one screening by immunochemical fecal occult blood test. Dis Colon Rectum. 2001; 44(11):1696-9. DOI: 10.1007/BF02234392. View

Bhandari A, Woodhouse M, Gupta S . Colorectal cancer is a leading cause of cancer incidence and mortality among adults younger than 50 years in the USA: a SEER-based analysis with comparison to other young-onset cancers. J Investig Med. 2016; 65(2):311-315. PMC: 5564445. DOI: 10.1136/jim-2016-000229. View

Brawley O . Colorectal cancer control: providing adequate care to those who need it. J Natl Cancer Inst. 2014; 106(4):dju075. DOI: 10.1093/jnci/dju075. View

10.

Levin T, Corley D, Jensen C, Schottinger J, Quinn V, Zauber A . Effects of Organized Colorectal Cancer Screening on Cancer Incidence and Mortality in a Large Community-Based Population. Gastroenterology. 2018; 155(5):1383-1391.e5. PMC: 6240353. DOI: 10.1053/j.gastro.2018.07.017. View

11.

Morikawa T, Kato J, Yamaji Y, Wada R, Mitsushima T, Sakaguchi K . Sensitivity of immunochemical fecal occult blood test to small colorectal adenomas. Am J Gastroenterol. 2007; 102(10):2259-64. DOI: 10.1111/j.1572-0241.2007.01404.x. View

12.

Siegel R, Fedewa S, Anderson W, Miller K, Ma J, Rosenberg P . Colorectal Cancer Incidence Patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017; 109(8). PMC: 6059239. DOI: 10.1093/jnci/djw322. View

13.

Doubeni C, Corley D, Quinn V, Jensen C, Zauber A, Goodman M . Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study. Gut. 2016; 67(2):291-298. PMC: 5868294. DOI: 10.1136/gutjnl-2016-312712. View

14.

Gini A, Jansen E, Zielonke N, Meester R, Senore C, Anttila A . Impact of colorectal cancer screening on cancer-specific mortality in Europe: A systematic review. Eur J Cancer. 2020; 127:224-235. DOI: 10.1016/j.ejca.2019.12.014. View

15.

Wolf A, Fontham E, Church T, Flowers C, Guerra C, LaMonte S . Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018; 68(4):250-281. DOI: 10.3322/caac.21457. View

16.

Pearlman R, Frankel W, Swanson B, Zhao W, Yilmaz A, Miller K . Prevalence and Spectrum of Germline Cancer Susceptibility Gene Mutations Among Patients With Early-Onset Colorectal Cancer. JAMA Oncol. 2016; 3(4):464-471. PMC: 5564179. DOI: 10.1001/jamaoncol.2016.5194. View

17.

Chang L, Shun C, Hsu W, Tu C, Tsai P, Lin B . Fecal Immunochemical Test Detects Sessile Serrated Adenomas and Polyps With a Low Level of Sensitivity. Clin Gastroenterol Hepatol. 2016; 15(6):872-879.e1. DOI: 10.1016/j.cgh.2016.07.029. View

18.

Patel S, May F, Anderson J, Burke C, Dominitz J, Gross S . Updates on Age to Start and Stop Colorectal Cancer Screening: Recommendations From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2021; 162(1):285-299. DOI: 10.1053/j.gastro.2021.10.007. View

19.

Haug U, Kuntz K, Knudsen A, Hundt S, Brenner H . Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia. Br J Cancer. 2011; 104(11):1779-85. PMC: 3111170. DOI: 10.1038/bjc.2011.160. View

20.

Symonds E, Osborne J, Cole S, Bampton P, Fraser R, Young G . Factors affecting faecal immunochemical test positive rates: demographic, pathological, behavioural and environmental variables. J Med Screen. 2015; 22(4):187-93. DOI: 10.1177/0969141315584783. View