Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial
Abstract Annual fecal immunochemical testing (FIT) is cost‐effective for colorectal cancer (CRC) screening. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false‐positive (FP) results adding to colonoscopy burden without improving cancer detection. Our...
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| Format: | Article |
| Language: | English |
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Wiley
2018-09-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.1727 |
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| author | Carrie M. Nielson Amanda F. Petrik Lorie Jacob William M. Vollmer Erin M. Keast Jennifer L. Schneider Jennifer S. Rivelli Tanya J. Kapka Richard T. Meenan Rajasekhara R. Mummadi Beverly B. Green Gloria D. Coronado |
| author_facet | Carrie M. Nielson Amanda F. Petrik Lorie Jacob William M. Vollmer Erin M. Keast Jennifer L. Schneider Jennifer S. Rivelli Tanya J. Kapka Richard T. Meenan Rajasekhara R. Mummadi Beverly B. Green Gloria D. Coronado |
| author_sort | Carrie M. Nielson |
| collection | DOAJ |
| description | Abstract Annual fecal immunochemical testing (FIT) is cost‐effective for colorectal cancer (CRC) screening. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false‐positive (FP) results adding to colonoscopy burden without improving cancer detection. Our objective was to describe FIT PPV and the factors associated with FP results among patients undergoing CRC screening. In an ongoing pragmatic clinical trial of mailed‐FIT outreach, clinics delivered one of three FIT brands (InSure, OC‐Micro, and Hemosure). Patients who had a positive FIT result and a follow‐up colonoscopy were included in this analysis (N = 1130). Patients’ demographic and medical histories were abstracted from electronic health records (EHR). Associations with a FP result (ie, a positive FIT result with no evidence of advanced neoplasia during follow‐up colonoscopy) were evaluated for FIT brand and patient factors using mixed‐effects multivariable logistic regression. The mean proportion of FIT‐positive results ranged from 8% in centers using the OC‐Micro test to 21% for Hemosure. PPVs for advanced neoplasia were 0.30 to 0.17, respectively (P for χ2 = 0.08). In multivariable‐adjusted models, use of Hemosure was associated with greater odds of a FP result than OC‐Micro (OR = 2.00, 95% CI: 0.47‐8.56) or InSure (OR = 1.72, 95% CI: 0.44‐6.68). However, only female sex (OR = 1.58, 95% CI: 1.19‐2.10) and history of a colorectal condition (OR = 2.17, 95% CI: 1.13‐4.15) were significantly associated with FP. In conclusion, FIT positivity varied by brand, and FP results differed by patient factors available through the EHR. These results can be used to minimize the frequency of FP results, reducing patient distress and colonoscopy burden. |
| format | Article |
| id | doaj-art-be2b83896d2c46afad26fb1581a31e8f |
| institution | DOAJ |
| issn | 2045-7634 |
| language | English |
| publishDate | 2018-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-be2b83896d2c46afad26fb1581a31e8f2025-08-20T03:04:30ZengWileyCancer Medicine2045-76342018-09-01794781479010.1002/cam4.1727Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trialCarrie M. Nielson0Amanda F. Petrik1Lorie Jacob2William M. Vollmer3Erin M. Keast4Jennifer L. Schneider5Jennifer S. Rivelli6Tanya J. Kapka7Richard T. Meenan8Rajasekhara R. Mummadi9Beverly B. Green10Gloria D. Coronado11Kaiser Permanente Center for Health Research Portland OregonKaiser Permanente Center for Health Research Portland OregonOCHIN Portland OregonKaiser Permanente Center for Health Research Portland OregonKaiser Permanente Center for Health Research Portland OregonKaiser Permanente Center for Health Research Portland OregonKaiser Permanente Center for Health Research Portland OregonKaiser Permanente Center for Health Research Portland OregonKaiser Permanente Center for Health Research Portland OregonKaiser Permanente Center for Health Research Portland OregonKaiser Permanente Washington Health Research Institute Seattle WashingtonKaiser Permanente Center for Health Research Portland OregonAbstract Annual fecal immunochemical testing (FIT) is cost‐effective for colorectal cancer (CRC) screening. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false‐positive (FP) results adding to colonoscopy burden without improving cancer detection. Our objective was to describe FIT PPV and the factors associated with FP results among patients undergoing CRC screening. In an ongoing pragmatic clinical trial of mailed‐FIT outreach, clinics delivered one of three FIT brands (InSure, OC‐Micro, and Hemosure). Patients who had a positive FIT result and a follow‐up colonoscopy were included in this analysis (N = 1130). Patients’ demographic and medical histories were abstracted from electronic health records (EHR). Associations with a FP result (ie, a positive FIT result with no evidence of advanced neoplasia during follow‐up colonoscopy) were evaluated for FIT brand and patient factors using mixed‐effects multivariable logistic regression. The mean proportion of FIT‐positive results ranged from 8% in centers using the OC‐Micro test to 21% for Hemosure. PPVs for advanced neoplasia were 0.30 to 0.17, respectively (P for χ2 = 0.08). In multivariable‐adjusted models, use of Hemosure was associated with greater odds of a FP result than OC‐Micro (OR = 2.00, 95% CI: 0.47‐8.56) or InSure (OR = 1.72, 95% CI: 0.44‐6.68). However, only female sex (OR = 1.58, 95% CI: 1.19‐2.10) and history of a colorectal condition (OR = 2.17, 95% CI: 1.13‐4.15) were significantly associated with FP. In conclusion, FIT positivity varied by brand, and FP results differed by patient factors available through the EHR. These results can be used to minimize the frequency of FP results, reducing patient distress and colonoscopy burden.https://doi.org/10.1002/cam4.1727cancercolorectalfecal immunochemical testneoplasiascreening |
| spellingShingle | Carrie M. Nielson Amanda F. Petrik Lorie Jacob William M. Vollmer Erin M. Keast Jennifer L. Schneider Jennifer S. Rivelli Tanya J. Kapka Richard T. Meenan Rajasekhara R. Mummadi Beverly B. Green Gloria D. Coronado Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial Cancer Medicine cancer colorectal fecal immunochemical test neoplasia screening |
| title | Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial |
| title_full | Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial |
| title_fullStr | Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial |
| title_full_unstemmed | Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial |
| title_short | Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial |
| title_sort | positive predictive values of fecal immunochemical tests used in the stop crc pragmatic trial |
| topic | cancer colorectal fecal immunochemical test neoplasia screening |
| url | https://doi.org/10.1002/cam4.1727 |
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