Evidence map›Paper›PMID 30538097›Full record

ArticleGut2019

Faecal immunochemical tests (FIT) versus colonoscopy for surveillance after screening and polypectomy: a diagnostic accuracy and cost-effectiveness study.

Amanda J Cross, Kate Wooldrage, Emma C Robbins, Ines Kralj-Hans, Eilidh MacRae, Carolyn Piggott, Iain Stenson, Aaron Prendergast, Bhavita Patel, Kevin Pack and 8 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Gut, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 2 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

45 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
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  7. Feasibility and Acceptability of Noninvasive Stool Testing for Surveillance of Colorectal Polyps in Older Adults.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

Amanda J CrossCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.ORCID 0000-0002-0893-2377
Kate WooldrageCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Emma C RobbinsCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Ines Kralj-HansCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Eilidh MacRaeCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Carolyn PiggottBowel Cancer Screening Programme Southern Hub, Guildford, UK.
Iain StensonCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Aaron PrendergastCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Bhavita PatelCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Kevin PackCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Rosemary HoweCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Nicholas SwartDepartment of Applied Health Research, University College London, London, UK.
Julia SnowballBowel Cancer Screening Programme Southern Hub, Guildford, UK.
Stephen W DuffyCentre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, UK.
Stephen MorrisDepartment of Applied Health Research, University College London, London, UK.
Christian von WagnerResearch Department of Behavioural Science and Health, University College London, London, UK.
Stephen P HalloranBowel Cancer Screening Programme Southern Hub, Guildford, UK.
Wendy S AtkinCancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.

Funding

Cancer Research UK 25004Department of Health 09/22/192
6 · The paper itself

Abstract

objectiveThe 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.

designIntermediate-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.

results74% (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.

conclusionsReplacing 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.

Indexed as

Occult BloodAdenomaAgedColonic PolypsColonoscopyColorectal NeoplasmsCost-Benefit AnalysisEarly Detection of CancerEnglandFalse Negative ReactionsFemaleHealth Care CostsHumansMaleMiddle AgedPopulation Surveillanceadenomacolonoscopycolorectal cancerstool markerssurveillance

Identifiers

PMID30538097
PMCPMC6709777

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

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.