Manuel Zorzi, MD, MSc; Cesare Hassan, MD; Giulia Capodaglio, MS; Elena Narne, MD; Anna Turrin, MS; Maddalena Baracco, MSc; Antonella Dal Cin, MSc; Annarita Fiore, MSc; Giancarla Martin, LPN; Alessandro Repici, MD; Douglas Rex, MD; Massimo Rugge, MD
Disclosures: Dr. Hassan reports personal fees from Fujifilm, Norgine, and Sonoscape and nonfinancial support from Olympus outside the submitted work. Dr. Rex reports personal fees from Olympus and Boston Scientific outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0855.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Ms. Capodaglio (e-mail, firstname.lastname@example.org).
Corresponding Author: Manuel Zorzi, MD, MSc, Veneto Tumour Registry, Azienda Zero, Passaggio Gaudenzio, 1 - 35131 Padova, Italy; e-mail, email@example.com.
Current Author Addresses: Dr. Zorzi, Ms. Baracco, Ms. Dal Cin, Ms. Fiore, and Ms. Martin: Veneto Tumour Registry, Azienda Zero, Passaggio Gaudenzio, 1 - 35131 Padova, Italy.
Dr. Hassan: Endoscopy Unit, Nuovo Regina Margherita Hospital, Via Emilio Morosini, 30 - 00153 Rome, Italy.
Ms. Capodaglio: Regional Epidemiology Service, Azienda Zero, Passaggio Gaudenzio, 1 - 35131 Padova, Italy.
Dr. Narne and Ms. Turrin: Screening and Health Impact Evaluation, Azienda Zero, Passaggio Gaudenzio, 1 - 35131 Padova, Italy.
Dr. Repici: Endoscopy Unit, Humanitas University. Via Alessandro Manzoni, 113 - 20089 Rozzano (Milan), Italy.
Dr. Rex: Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, IN 46202.
Dr. Rugge: Department of Medicine–DIMED, Pathology and Cytopathology Unit, University of Padova, Via Gabelli, 61 - 35121 Padova, Italy.
Author Contributions: Conception and design: M. Zorzi, C. Hassan, M. Rugge.
Analysis and interpretation of the data: M. Zorzi, C. Hassan, G. Capodaglio, A. Repici, D. Rex.
Drafting of the article M. Zorzi, C. Hassan, A. Repici.
Critical revision for important intellectual content: M. Zorzi, C. Hassan, G. Capodaglio, M. Baracco, A. Dal Cin, A. Fiore, G. Martin, A. Repici.
Final approval of the article: M. Zorzi, C. Hassan, G. Capodaglio, E. Narne, A. Turrin, M. Baracco, A. Dal Cin, A. Fiore, G. Martin, A. Repici, D. Rex, M. Rugge.
Statistical expertise: M. Zorzi, A. Turrin.
Collection and assembly of data: E. Narne, G. Martin.
Short-term studies have reported that the fecal immunochemical test (FIT) is less accurate in detecting proximal than distal colorectal neoplasia.
To assess the long-term detection rates for advanced adenoma and colorectal cancer (CRC), according to anatomical location.
Population-based, organized screening program in the Veneto region of Italy.
Persons aged 50 to 69 years who completed 6 rounds of FIT screening.
At each screening round, the detection rates for advanced adenoma and cancer, as well as the proportional interval cancer rate (PICR), were calculated by anatomical location (proximal colon, distal colon, or rectum).
Between 2002 and 2014, a total of 123 347 participants had 441 647 FITs. The numbers of advanced adenomas and cancer cases detected, respectively, were 1704 and 200 in the proximal colon, 3703 and 324 in the distal colon, and 1220 and 209 in the rectum. Although the detection rate for proximal colon cancer declined only from the first to the second screening round (0.63 to 0.36 per 1000 screenees), the rate for both distal colon and rectal cancer steadily decreased across 6 rounds (distal colon, 1.65 in the first round to 0.17 in the sixth; rectum, 0.82 in the first round to 0.17 in the sixth). Similar trends were found for advanced adenoma (proximal colon, 5.32 in the first round to 4.22 in the sixth; distal colon, 15.2 in the first round to 5.02 in the sixth). Overall, 150 cases of interval cancer were diagnosed. The PICR was higher in the proximal colon (25.2% [95% CI, 19.9% to 31.5%]) than the distal colon (6.0% [CI, 3.9% to 8.9%]) or rectum (9.9% [CI, 6.9% to 13.7%]).
Participants with irregular attendance were censored. Those who had a false-positive result on a previous FIT but negative colonoscopy results were included in subsequent rounds.
This FIT-based, multiple-round, long-term screening program had a negligible reduction in detection rates for neoplastic lesions in the proximal versus the distal colon after the first round. This was related to a higher PICR in the proximal colon and suboptimal efficacy in preventing the age-related proximal shifting of CRC.
Zorzi M, Hassan C, Capodaglio G, Narne E, Turrin A, Baracco M, et al. Divergent Long-Term Detection Rates of Proximal and Distal Advanced Neoplasia in Fecal Immunochemical Test Screening Programs: A Retrospective Cohort Study. Ann Intern Med. ;169:602–609. doi: 10.7326/M18-0855
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Published: Ann Intern Med. 2018;169(9):602-609.
Published at www.annals.org on 2 October 2018
Cancer Screening/Prevention, Hematology/Oncology, Prevention/Screening.
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