The National Health Service Bowel Cancer Screening Programme (BCSP) in England uses a guaiac-based fecal occult blood test.
A quantitative fecal immunochemical test for hemoglobin has many advantages, including being specific for human blood, detecting Hb at a much lower concentration with a single fecal sample and improved uptake.
In 2014, a large comparative pilot study was performed within BCSP to establish the acceptability and diagnostic performance of fecal immunochemical test.
Dr Sue Moss and colleagues sent 40,930 subjects a fecal immunochemical test (OC-SENSOR) instead of a guaiac-based fecal occult blood test, over a 6-month period.
|Overall uptake increased by over 7 percentage points with fecal immunochemical test|
A bespoke fecal immunochemical test package was used to mail fecal immunochemical test sampling devices to and from fecal immunochemical test subjects.
All participants positive with either guaiac-based fecal occult blood test or fecal immunochemical test were referred for follow-up.
Subgroup analysis included cut-off concentrations, age, sex, screening history and deprivation quintile.
While overall uptake increased by over 7 percentage points with fecal immunochemical test, the team found that uptake by previous non-responders almost doubled.
The team found that increase in overall uptake was significantly higher in men than women and was observed across all deprivation quintiles.
With the conventional 20 µg/g cut-off, fecal immunochemical test positivity was 8%, and ranged from 6% in 59–64-year-old women to 11% in 70- to 75-year-old men.
The researchers observed that cancer detection increased 2-fold and that for advanced adenomas nearly 5-fold.
The team noted that detection rates remained higher with fecal immunochemical test for advanced adenomas, even at 180 µg hemoglobin/g.
Dr Moss' team concludes, "Markedly improved participation rates were achieved in a mature guaiac-based fecal occult blood test-based national screening program, and disparities between men and women were reduced."
"High positivity rates, particularly in men and previous non-respondents, challenge the available colonoscopy resource, but improvements in neoplasia detection are still achievable within this limited resource."