Diagnostic accuracy of fecal immunochemical testing and factors associated with colorectal cancer among individuals aged over 45 years at Damnoen Saduak Hospital, Ratchaburi
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Abstract
Objective: This study aims to evaluate the accuracy of colorectal cancer screening using the Fecal Immunochemical Test (FIT) and to identify factors associated with colorectal cancer among patients at Damnoen Saduak Hospital, Ratchaburi.
Methods: This study employed an analytical cross-sectional design. The study population comprised patients aged 45 years and older who had undergone colorectal cancer screening using the Fecal Immunochemical Test (FIT) and subsequently underwent colonoscopy for further diagnostic evaluation. Data was collected from March 1, 2024, to December 31, 2024. A simple random sampling method was used to select 230 participants. Data analysis included descriptive statistics, a chi-square test, an independent t-test, and an odds ratio comparison between the case and control groups. Binary logistic regression analysis was performed to identify significant predictors of colorectal cancer. Statistically significant at p<0.05
Results: At Damnoen Saduak Hospital, the accuracy of the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening was 35.65%, with a CRC detection rate of 10.87%. FIT demonstrated a sensitivity of 56.00% and specificity of 33.17%. Patients with CRC were older and had higher APCS scores. Significant associated factors included diabetes mellitus, hematochezia, and anemia. Independent predictors of CRC were APCS score (OR=1.57) and hematochezia (OR=9.96), while other clinical factors showed no significant association.
Conclusion: FIT is a useful tool for colorectal cancer screening among screening participants. Considering clinical factors such as mucous bloody stool and APCS score may enhance risk stratification and help prioritize individuals for colonoscopy. However, these risk factors do not necessarily occur together in all patients and should be interpreted within the overall clinical context.
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References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394-424.
National Cancer Institute Thailand. Annual report 2023 [Internet]. Bangkok: National Cancer Institute; 2023 [cited 2026 Feb 25]. Available from: https://www.nci.go.th/doc/report/report_doc_1768897041_111.pdf
O’Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst [Internet]. 2004 [cited 2022 Nov 26];96(19):1420-5. Available from: https://pubmed.ncbi.nlm.nih.gov/15467030/
Lauby-Secretan B, Vilahur N, Bianchini F, Guha N, Straif K; International Agency for Research onCancer Handbook Working Group. The IARC perspective on colorectal cancer screening. N Engl JMed [Internet]. 2018 [cited 2022 Dec 25];378(18):1734-40. Available from: https://NEJMsr1714643
Lee JK, Liles EG, Bent S, Levin TR, Corley DA. Accuracy of fecal immunochemical tests for colorectal cancer: systematic review and meta-analysis. Ann Intern Med [Internet]. 2014 [cited 2022 Nov 22];160(3):171. Available from: https://pubmed.ncbi.nlm.nih.gov/24658694/
Bray C, Bell LN, Liang H, Collins D, Yale SH. Colorectal cancer screening. WMJ 2017;116(1):27-33.
Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al; American Cancer Society Colorectal Cancer Advisory Group; US Multi-Society Task Force; American College of Radiology Colon Cancer Committee. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on colorectal cancer, and the American College of Radiology. Gastroenterology [Internet]. 2008 [cited 2022 Dec 27];134(5):1570-95. Available from: https://pubmed.ncbi.nlm.nih.gov/18384785/
Kavanagh AM, Giovannucci EL, Fuchs CS, Colditz GA. Screening endoscopy and risk of colorectal cancer in United states men. Cancer Causes Control [Internet]. 1998 [cited 2022 Dec 27];9(4):455-62. Available from: https://pubmed.ncbi.nlm.nih.gov/9794179/
Parra-Blanco A, Gimeno-Garcia AZ, Quintero E, Nicolas D, Moreno SG, Jimenez A, et al. Diagnostic accuracy of immunochemical versus guaiac faecal occult blood tests for colorectal cancer screening. J Gastroenterol [Internet]. 2010 [cited 2022 Dec 25];45(7):703-12. Available from: https://link.springer.com/article/10.1007/s00535-010-0214-8
Robertson DJ, Lee JK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US Multi-Society Task Force on colorectal cancer. Gastroenterology [Internet]. 2017 [cited 2022 Dec 27];152(5):1217-37.e3. Available from: https://pubmed.ncbi.nlm.nih.gov/27769517/
Yeoh KG, Ho KY, Chiu HM, Zhu F, Ching JYL, Wu DC, et al; Asia-Pacific Working Group on Colorectal Cancer. The Asia-Pacific colorectal screening score: a validated tool that stratifies risk for colorectal advanced neoplasia in asymptomatic Asian subjects. Gut [Internet]. 2011 [cited 2022 Dec 27];60(9):1236-41. Available from: https://pubmed.ncbi.nlm.nih.gov/21402615/
Sung JJY, Wong MCS, Lam TYT, Tsoi KKF, Chan VCW, Cheung W, et al. A modified colorectal screening score for prediction of advanced neoplasia: a prospective study of 5744 subjects. J Gastroenterol Hepatol [Internet]. 2018 [cited 2025 Feb 2];33(1):187-94. Available from: https://pubmed.ncbi.nlm.nih.gov/28561279/
He XX, Yuan SY, Li WB, Yang H, Ji W, Wang ZQ, et al. Improvement of Asia-Pacific colorectal screening score and evaluation of its use combined with fecal immunochemical test. BMC Gastroenterol [Internet]. 2019 [cited 2025 Feb 1];19(1):226. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6935212/
Rojanasiraprapa W. Accuracy of FIT test in screening colorectal cancer in Bang Bo Hospital, Samut Prakan Province. The Journal of Prapokklao Hospital Clinical Medical Education Center [Internet]. 2020 [cited 2025 Feb 2];37(1):35-43. Available from: https://he02.tci-thaijo.org/index.php/ppkjournal/article/view/218467/163669 (in Thai)
Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med [Internet]. 2014 [cited 2025 Feb 1];370(14):1287–97. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa1311194
Khan AA, Klimovskij M, Harshen R. Accuracy of faecal immunochemical testing in patients with symptomatic colorectal cancer. BJS Open [Internet]. 2020 [cited 2025 Feb 2];4(6):1180-8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7709370/
Jin P, Wu Z, Meng M, Wang X, Wang X, Gong L, et al. Combined fecal transferrin test and immuno fecal cccult blood test for detecting colorectal cancer and advanced adenoma in asymptomatic and symptomatic populations. J Cancer Sci Ther [Internet]. 2012 [cited 2025 Feb 2];4(8):243-8. Available from: https://www.hilarispublisher.com/open-access/combined-fecal-transferrin-test-and-immuno-fecal-occult-blood-test-for-detecting-colorectal-cancer-and-advanced-adenoma-in-asymptomaticand-symptomatic-populations-1948-5956.1000149.pdf
Lue A, Hijos G, Sostres C, Perales A, Navarro M, Barra MV, et al. The combination of quantitative faecal occult blood test and faecal calprotectin is a cost-effective strategy to avoid colonoscopies in symptomatic patients without relevant pathology. Ther Adv Gastroenterol [Internet]. 2020 [cited 2025 Jan 28];13:1756284820920786. Available from: https://pubmed.ncbi.nlm.nih.gov/32523623/
Selby K, Levine EH, Doan C, Gies A, Brenner H, Quesenberry C, et al. Effect of sex, age, and positivity threshold on fecal immunochemical test accuracy: a systematic review and meta-analysis. Gastroenterology [Internet]. 2019 [cited 2025 Feb 2];157(6):1494-505. Available from: https://pubmed.ncbi.nlm.nih.gov/31472152/
Hijos-Mallada G, Saura N, Lue A, Velamazan R, Nieto R, Navarro M, et al. A point-of-care faecal test combining four biomarkers allows avoidance of normal colonoscopies and prioritizes symptomatic patients with a high risk of colorectal cancer. Cancers (Basel) [Internet]. 2023 [cited 2025 Jan 28];15(3):721. Available from: https://pubmed.ncbi.nlm.nih.gov/36765678/
Wu GH, Wang YM, Yen AM, Wong JM, Lai HC, Warwick J, et al. Cost-effectiveness analysis of colorectal cancer screening with stool DNA testing in intermediate-incidence countries. BMC Cancer [Internet]. 2006 [cited 2025 Feb 2];6:136. Available from: https://pubmed.ncbi.nlm.nih.gov/16723013/
Li W, Zhang L, Hao J, Wu Y, Lu D, Zhao H, et al. Validity of APCS score as a risk prediction score for advanced colorectal neoplasia in Chinese asymptomatic subjects: a prospective colonoscopy study. Medicine (Baltimore) [Internet]. 2016 [cited 2022 Dec 26];95(41):e5123. Available from: https://pubmed.ncbi.nlm.nih.gov/27741134/
Ze Y, Tu HM, Zhao YY, Zhang L. Developing a nomogram for predicting colorectal cancer and its precancerous lesions based on data from three non-invasive screening tools, APCS, FIT, and sDNA.
J Multidiscip Healthc 2024;17:2891-901.
Adelstein BA, Macaskill P, Turner RM, Katelaris PH, Irwig L. The value of age and medical history for predicting colorectal cancer and adenomas in people referred for colonoscopy. BMC Gastroenterol [Internet]. 2011 [cited 2025 Feb 2];11:97. Available from: http://www.biomedcentral.com/1471-230X/11/97
Olde Bekkink M, McCowan C, Falk GA, Teljeur C, Van de Laar FA, Fahey T. Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer. Br J Cancer [Internet]. 2010 [cited 2025 Feb 2];102(1):48-58. Available from: https://pubmed.ncbi.nlm.nih.gov/19935790/
US Preventive Services Task Force. Screening for colorectal cancer: US PreventiveServices Task Force recommendation statement. JAMA [Internet]. 2021 [cited 2023 Jan 2];325(19):1965-77. Available from: https://jamanetwork.com/journals/jama/fullarticle/2779985
Cubiella J, Vega P, Salve M, Diaz-Ondina M, Alves MT, Quintero E, et al; COLONPREDICT study investigators. Development and external validation of a faecal immunochemical test-based prediction model for colorectal cancer detection in symptomatic patients. BMC Med [Internet]. 2016 [cited 2025 Feb 2];14(1)128. Available from: https://pubmed.ncbi.nlm.nih.gov/27580745/
Alatise OI, Ayandipo OO, Adeyeye A, Seier K, Komolafe AO, Bojuwoye MO, et al. A symptom-based model to predict colorectal cancer in low-resource countries: results from a prospective study of patients at high risk for colorectal cancer. Cancer [Internet]. 2018 [cited 2025 Feb 2];124(13):2766-73. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6005740/
Ng SC, Wong SH. Colorectal cancer screening in Asia. Br Med Bull [Internet]. 2013 [cited 2025 Feb 2];105:29-42. Available from: https://pubmed.ncbi.nlm.nih.gov/23299409/
