Veterans Affairs San Diego Healthcare System, San Diego, California; University of California, San Diego, La Jolla, California.
Veterans Affairs San Diego Healthcare System, San Diego, California.
Clin Gastroenterol Hepatol. 2017 Aug;15(8):1265-1270.e1. doi: 10.1016/j.cgh.2017.01.025. Epub 2017 Feb 4.
BACKGROUND & AIMS: The most commonly used noninvasive test for colorectal cancer (CRC) screening has been the guaiac fecal occult blood test (gFOBT). The fecal immunochemical test (FIT) detects CRC and colorectal polyps with higher levels of sensitivity than the gFOBT, and may be more acceptable to patients. However, the FIT has not replaced the gFOBT in many clinical settings. We analyzed data from a large healthcare system that replaced the gFOBT with the FIT to determine the effects on CRC screening.
We conducted a retrospective observational study of 7898 patients at the Veterans' Administration San Diego Healthcare System, 50-75 years old, who were offered stool-based CRC screening as part of primary care March 2014 through January 2015. Test orders and results were extracted from electronic health records; we performed manual reviews of colonoscopy and pathology reports for Veterans with positive results from the tests. Our primary outcome was test completion within 1 year of order; secondary outcomes were positive results and detection of advanced neoplasia by diagnostic colonoscopy. The primary analysis used an intention-to-screen approach, which included all patients with test orders; as-screened analyses were also performed.
Among 7898 patients, 3236 had gFOBT and 4662 FIT orders. In the intention to screen analysis, a significantly higher proportion of subjects completed a FIT (42.6%) than a gFOBT (33.4%) (P < .001); advanced neoplasia was detected in a significantly higher proportion of subjects offered a FIT (0.79%) than a gFOBT (0.28%) (P = .003). The numbers needed to invite to achieve 1 additional completed test and identify 1 additional patient with advanced neoplasia were 11 and 196, respectively.
In a retrospective study of patients at a Veterans' administration healthcare system, replacing the gFOBT with the FIT increased the proportion of patients who completed CRC screening. Replacement of the gFOBT with the FIT should be strongly considered by all healthcare systems.
结直肠癌（CRC）筛查最常用的非侵入性检测方法一直是愈创木脂粪便潜血试验（gFOBT）。粪便免疫化学试验（FIT）检测 CRC 和结直肠息肉的灵敏度高于 gFOBT，并且可能更受患者接受。然而，在许多临床环境中，FIT 并未替代 gFOBT。我们分析了来自大型医疗保健系统的数据，该系统用 FIT 替代了 gFOBT，以确定对 CRC 筛查的影响。
我们对 Veterans' Administration San Diego Healthcare System 的 7898 名年龄在 50-75 岁的患者进行了回顾性观察性研究，这些患者在 2014 年 3 月至 2015 年 1 月期间作为初级保健的一部分接受了基于粪便的 CRC 筛查。测试订单和结果从电子健康记录中提取；我们对测试结果阳性的退伍军人的结肠镜检查和病理报告进行了手动审查。我们的主要结局是在下达测试命令后 1 年内完成测试；次要结局是阳性结果和通过诊断性结肠镜检查检测到高级肿瘤。主要分析采用了意向筛查方法，该方法包括所有接受测试命令的患者；还进行了按筛查分析。
在 7898 名患者中，有 3236 名接受了 gFOBT 和 4662 名接受了 FIT 订单。在意向筛查分析中，完成 FIT 的受试者比例（42.6%）明显高于 gFOBT（33.4%）（P<0.001）；提供 FIT 的受试者中高级肿瘤的检出率明显高于 gFOBT（0.79%）（0.28%）（P=0.003）。每邀请一人即可完成一项额外测试，每邀请 196 人即可发现一名患有高级肿瘤的患者。
在 Veterans' Administration 医疗保健系统的患者回顾性研究中，用 FIT 替代 gFOBT 增加了完成 CRC 筛查的患者比例。所有医疗保健系统都应强烈考虑用 FIT 替代 gFOBT。
