Evidence map›Paper›PMID 28851318›Full record

ArticleBMC cancer2017

Population-based colorectal cancer screening programmes using a faecal immunochemical test: should faecal haemoglobin cut-offs differ by age and sex?

Eunate Arana-Arri, Isabel Idigoras, Begoña Uranga, Raquel Pérez, Ana Irurzun, Iñaki Gutiérrez-Ibarluzea, Callum G Fraser, Isabel Portillo, EUSKOLON Group

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In one paragraph

Article in BMC cancer, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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  7. Sex-Specific Outcomes after a Negative Colonoscopy in the Finnish Randomized Health Service Study during 2004 to 2016.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025
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  11. Gender and sex differences in colorectal cancer screening, diagnosis and treatment.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Eunate Arana-ArriBioCruces Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain. eunate.aranaarri@osakidetza.eus.
Isabel IdigorasColorectal Cancer Screening Programme Coordination Center, Bilbao, Spain.
Begoña UrangaClinical Biochemistry Service, Donostia University Hospital, Basque Health Service, Donostia, Gipuzkoa, Spain.
Raquel PérezClinical Biochemistry Service, Cruces University Hospital, Basque Health Service, Barakaldo, Bizkaia, Spain.
Ana IrurzunClinical Biochemistry Service, Donostia University Hospital, Basque Health Service, Donostia, Gipuzkoa, Spain.
Iñaki Gutiérrez-IbarluzeaOsteba, Basque Office for Health Technology Assessment, Ministry for Health, Vitoria-Gasteiz, Spain.
Callum G FraserCentre for Research into Cancer Prevention & Screening, University of Dundee, Dundee, Scotland.
Isabel PortilloCentre for Research into Cancer Prevention & Screening, University of Dundee, Dundee, Scotland.
EUSKOLON Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Basque Colorectal Cancer Screening Programme has both high participation rate and high compliance rate of colonoscopy after a positive faecal occult blood test (FIT). Although, colorectal cancer (CRC) screening with biannual (FIT) has shown to reduce CRC mortality, the ultimate effectiveness of the screening programmes depends on the accuracy of FIT and post-FIT colonoscopy, and thus, harms related to false results might not be underestimated. Current CRC screening programmes use a single faecal haemoglobin concentration (f-Hb) cut-off for colonoscopy referral for both sexes and all ages. We aimed to determine optimum f-Hb cut-offs by sex and age without compromising neoplasia detection and interval cancer proportion.

methodsProspective cohort study using a single-sample faecal immunochemical test (FIT) on 444,582 invited average-risk subjects aged 50-69 years. A result was considered positive at ≥20 μg Hb/g faeces. Outcome measures were analysed by sex and age for a wide range of f-Hb cut-offs.

resultsWe analysed 17,387 positive participants in the programme who underwent colonoscopy. Participation rate was 66.5%. Men had a positivity rate for f-Hb of 8.3% and women 4.8% (p < 0.0001). The detection rate for advanced neoplasia (cancer plus advanced adenoma) was 44.0‰ for men and 15.9‰ for women (p < 0.0001). The number of colonoscopies required decreased in both sexes and all age groups through increasing the f-Hb cut-off. However, the loss in CRC detection increased by up to 28.1% in men and 22.9% in women. CRC missed were generally at early stages (Stage I-II: from 70.2% in men to 66.3% in women).

conclusionsThis study provides detailed outcomes in men and women of different ages at a range of f-Hb cut-offs. We found differences in positivity rates, neoplasia detection rate, number needed to screen, and interval cancers in men and women and in younger and older groups. However, there are factors other than sex and age to consider when consideration is given to setting the f-Hb cut-off.

Indexed as

Occult BloodAgedAge DistributionColorectal NeoplasmsEarly Detection of CancerFemaleHemoglobinsHumansMaleMass ScreeningMiddle AgedProspective StudiesSensitivity and SpecificitySex FactorsSpainHemoglobinsAdenomaColorectal cancerFaecal immunochemical testFaecal occult blood testInterval cancersScreening

Identifiers

PMID28851318
PMCPMC5576224

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.