INTERVAL COLORECTAL CANCERS AFTER NEGATIVE FECAL

IMMUNOCHEMICAL TEST IN A 13-YEAR SCREENING PROGRAM

• Hassan C

• ‚Nuovo Regina Margherita Hospital‘, Rome, Italy

Popolazione ISTAT, popolazione target, invitati e screenati ITALIA 2005 - 2016

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

13873

15856

16194

4421 (32%)

13592

(84%)

811 (12%) 5553

(69%)369 (5%)

2206 (27%)

0

4000

8000

12000

16000

20000

x 1

00

0

screenati invitati popolazione target popolazione ISTAT

The OLDER you are The BETTER it is!

Emilia Romagna. Tassi di incidenza del tumore del colon retto. Età 50-69 anni

Courtesy Alessandra Ravaioli

Tassi standardizzati di mortalità per tumore del colon-retto, per periodo di attivazione

Residenti di 50-74 anni; tassi standardizzati sulla popolazione europea

- 22%

LONG-TERM PERFORMANCE OF COLORECTAL CANCER

SCREENING PROGRAMMES BASED ON THE FAECAL

IMMUNOCHEMICAL TEST

DISTAL

PROXIMAL

DISTAL

PROXIMAL

Interval CRC in FIT program

• After a negative FIT, interval cancer risk:

– Progression of an undetected CRC

– Progression of an undetected advanced adenoma

– De novo CRC

Interval CRC in FIT program

• Uncertainty on log-term risk of IC due to:

– Most available data limited to 1-2 rounds

– Two different systems for measuring IC: • Proportional Interval Cancer Rate (PICR)

– Rate of IC with and without FT screening (historical comparison)

• Interval Cancer Proportion (ICP) – IC/(IC+screen-detected)

Interval CRC in FIT program

Round All I II III IV V VI

Invited (n) 526644 178828 107253 83813 66862 53124 36764

Screened (n) 441647 123347 96129 78770 63069 50441 29891

Participation rate (%) 83.9 69.0 89.6 94.0 94.3 94.9 81.3

Gender (% of males screened) 46.6 47.7 46.7 46.3 45.8 45.6 45.5

Age (mean) 61.1 59.1 60.3 61.4 62.4 63.5 64.5

FIT positivity (%) 4.1 5.7 3.6 3.3 3.3 3.7 3.8

Compliance with colonoscopy (%) 93.3 91.5 94.0 94.7 94.9 94.3 93.8

Colorectal cancers diagnosed (n) 781 412 162 75 61 46 25

Colorectal cancer detection rate (x 1,000

screened) 1.77 3.34 1.69 0.95 0.97 0.91 0.84

Advanced adenomas diagnosed (n) 4713 1958 813 647 540 457 298

Advanced adenoma detection rate (x 1,000

screened) 10.7 15.9 8.5 8.2 8.6 9.1 10.0

Interval cancers after a negative FIT (n) 150 51 33 27 14 17 8

1 EVERY 2,761 FIT SCREENED SUBJECTS

Interval CRC in FIT program

Adjusted rate ratio* 95% confidence interval p value

Round

I**

II

III

IV

V

VI

1.00

0.76

0.71

0.44

0.67

0.89

-

0.49-1.18

0.44-1.14

0.24-0.80

0.38-1.16

0.42-1.91

-

0.22

0.15

0.007

0.15

0.77

Time since last FIT

0-11 months**

12-23 months

1.00

1.78

-

1.28-2.47

-

0.001

Age (years)

50-59**

60-71

1.00

2.37

-

1.61-3.50

-

<0.0001

Anatomical site

Colon, proximal

Colon, distal**

Rectum

3.00

1.00

1.35

1.92-4.68

-

0.81-2.24

<0.0001

-

0.25

Pre-

screening

Post-

screening No

screening Screen

detected (34%)

Non screen

detected

Numero di casi 6.710 2.806 6.759 7.393

Genere

Maschi

59%

62%

60%

58%

Età

65-69

38%

42%

38%

37%

Sede

Distale

38%

51%

36%

30%

Grading

1

2

3

NAS

10%

57%

16%

18%

20%

57%

11%

12%

9%

57%

17%

17%

6%

62%

16%

15%

SCREEN- vs. NON-SCREEN DETECTED

cv cv

FIT sensitivity for CRC

Interval CRC in FIT program

• Long-term risk of interval CRC is reassuringly marginal

• Predictive factors may lead to risk-startification:

– Longer FIT-interval in young subjects

– Proximal IC recommend continuation of FIT programs

• Both methods for FIT programmatic sensitivity for CRC

are biased by underlying CRC incidence prevention

– Absolute risk of IC as best measure