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dc.contributor.authorCross, Amanda J
dc.contributor.authorWooldrage, Kate
dc.contributor.authorRobbins, Emma C
dc.contributor.authorKralj-Hans, Ines
dc.contributor.authorMacRae, Eilidh
dc.contributor.authorPiggott, Carolyn
dc.contributor.authorStenson, Iain
dc.contributor.authorPrendergast, Aaron
dc.contributor.authorPatel, Bhavita
dc.contributor.authorPack, Kevin
dc.contributor.authorHowe, Rosemary
dc.contributor.authorSwart, Nicholas
dc.contributor.authorSnowball, Julia
dc.contributor.authorDuffy, Stephen W
dc.contributor.authorMorris, Stephen
dc.contributor.authorvon Wagner, Christian
dc.contributor.authorHalloran, Stephen P
dc.contributor.authorAtkin, Wendy S
dc.date.accessioned2020-09-11T23:30:47Z
dc.date.available2020-09-11T23:30:47Z
dc.date.issued2019-09
dc.identifier.issn0017-5749
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/310182
dc.description.abstractOBJECTIVE: The English Bowel Cancer Screening Programme (BCSP) recommends 3 yearly colonoscopy surveillance for patients at intermediate risk of colorectal cancer (CRC) postpolypectomy (those with three to four small adenomas or one ≥10 mm). We investigated whether faecal immunochemical tests (FITs) could reduce surveillance burden on patients and endoscopy services. DESIGN: Intermediate-risk patients (60-72 years) recommended 3 yearly surveillance were recruited within the BCSP (January 2012-December 2013). FITs were offered at 1, 2 and 3 years postpolypectomy. Invitees consenting and returning a year 1 FIT were included. Participants testing positive (haemoglobin ≥40 µg/g) at years one or two were offered colonoscopy early; all others were offered colonoscopy at 3 years. Diagnostic accuracy for CRC and advanced adenomas (AAs) was estimated considering multiple tests and thresholds. We calculated incremental costs per additional AA and CRC detected by colonoscopy versus FIT surveillance. RESULTS: 74% (5938/8009) of invitees were included in our study having participated at year 1. Of these, 97% returned FITs at years 2 and 3. Three-year cumulative positivity was 13% at the 40 µg/g haemoglobin threshold and 29% at 10 µg/g. 29 participants were diagnosed with CRC and 446 with AAs. Three-year programme sensitivities for CRC and AAs were, respectively, 59% and 33% at 40 µg/g, and 72% and 57% at 10 µg/g. Incremental costs per additional AA and CRC detected by colonoscopy versus FIT (40 µg/g) surveillance were £7354 and £180 778, respectively. CONCLUSIONS: Replacing 3 yearly colonoscopy surveillance in intermediate-risk patients with annual FIT could reduce colonoscopies by 71%, significantly cut costs but could miss 30%-40% of CRCs and 40%-70% of AAs. TRIAL REGISTRATION NUMBER: ISRCTN18040196; Results.
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherBMJ
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectHumans
dc.subjectAdenoma
dc.subjectColorectal Neoplasms
dc.subjectColonic Polyps
dc.subjectFalse Negative Reactions
dc.subjectColonoscopy
dc.subjectOccult Blood
dc.subjectPopulation Surveillance
dc.subjectSensitivity and Specificity
dc.subjectPredictive Value of Tests
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectCost-Benefit Analysis
dc.subjectHealth Care Costs
dc.subjectEngland
dc.subjectFemale
dc.subjectMale
dc.subjectEarly Detection of Cancer
dc.titleFaecal immunochemical tests (FIT) versus colonoscopy for surveillance after screening and polypectomy: a diagnostic accuracy and cost-effectiveness study.
dc.typeArticle
prism.endingPage1652
prism.issueIdentifier9
prism.publicationDate2019
prism.publicationNameGut
prism.startingPage1642
prism.volume68
dc.identifier.doi10.17863/CAM.57268
dcterms.dateAccepted2018-11-25
rioxxterms.versionofrecord10.1136/gutjnl-2018-317297
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2019-09
dc.contributor.orcidCross, Amanda J [0000-0002-0893-2377]
dc.identifier.eissn1468-3288
rioxxterms.typeJournal Article/Review
cam.issuedOnline2018-12-11


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International