OncologyImpact of age- and gender-specific cut-off values for the fecal immunochemical test for hemoglobin in colorectal cancer screening

BackgroundThere is no information on the impact of age and gender on the diagnostic yield of different positivity thresholds for the fecal immunochemical test for hemoglobin (FIT).ObjectivesTo evaluate the performance of this test at distinct positivity cut-offs in a population-based colorectal cancer (CRC) screening program.MethodsCRC detection rate (DR), and analysis of resources were evaluated retrospectively, at different cut-offs of FIT (20, 25, 30, 35 and 40 μg Hb/g) respect to a reference value (15 μg Hb/g), according to age and gender, in a screening population of 10,611 participants of the ColonPrev study (Quintero. NEJM 2013).ResultsAt the reference cut-off value, 36 CRC and 252 advanced adenomas (AA) were diagnosed. Increasing the cut-off in women ≤60 years decreases colonoscopies performed by 44.5% without modifying the CRC (DR). Same CRC DR was observed in men ≤60 years and women >60 years increasing cut-off at 25-30 μg Hb/g. In men >60 years, all increases in the cut-off affected the CRC DR, especially when the cut-off was increased from 35 to 40 μg Hb/g (CRC miss rate 25%).ConclusionsTo improve the performance of FIT in CRC screening programs, FIT cut-offs could be individualized by age and gender.