The optimal cut-off value in fit-based colorectal cancer screening: An observational study
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The optimal cut-off value in fit-based colorectal cancer screening : An observational study. / Njor, Sisse Helle; Andersen, Berit; Friis-Hansen, Lennart; de Haas, Niels; Linnemann, Dorte; Nørgaard, Henrik; Roikjaer, Ole; Søndergaard, Bo; Rasmussen, Morten.
In: Cancer Medicine, Vol. 10, No. 5, 03.2021, p. 1872-1879.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - The optimal cut-off value in fit-based colorectal cancer screening
T2 - An observational study
AU - Njor, Sisse Helle
AU - Andersen, Berit
AU - Friis-Hansen, Lennart
AU - de Haas, Niels
AU - Linnemann, Dorte
AU - Nørgaard, Henrik
AU - Roikjaer, Ole
AU - Søndergaard, Bo
AU - Rasmussen, Morten
N1 - © 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
PY - 2021/3
Y1 - 2021/3
N2 - BACKGROUND: Colorectal cancer (CRC) screening programs using fecal immunochemical test (FIT) have to choose a cut-off value to decide which citizens to recall for colonoscopy. The evidence on the optimal cut-off value is sparse and based on studies with a low number of cancer cases.METHODS: This observational study used data from the Danish Colorectal Cancer Screening Database. Sensitivity and specificity were estimated for various cut-off values based on a large number of cancers. Traditionally optimal cut-off values are found by weighting sensitivity and specificity equally. As this might result in too many unnecessary colonoscopies we also provide optimal cut-off values for different weighting of sensitivity and specificity/number of needed colonoscopies to detect one cancer.RESULTS: Weighting sensitivity and specificity equally gives an optimal cut-off value of 45 ng Hb/ml. This, however, means making 24 colonoscopies to detect one cancer. Weighting sensitivity lower and for example, aiming at making about 16 colonoscopies to detect one cancer, gives an optimal cut-off value of 125 ng Hb/ml.CONCLUSIONS: The optimal cut-off value in an FIT population-based screening program is 45 ng Hb/ml, when as traditionally sensitivity and specificity are weighted equally. If, however, 24 colonoscopies needed to detect one cancer is too huge a burden on the health care system and the participants, 80, 125, 175, and 350 ng Hb/ml are optimal cut-off values when only 19/16/14/10 colonoscopies are accepted to find one cancer.
AB - BACKGROUND: Colorectal cancer (CRC) screening programs using fecal immunochemical test (FIT) have to choose a cut-off value to decide which citizens to recall for colonoscopy. The evidence on the optimal cut-off value is sparse and based on studies with a low number of cancer cases.METHODS: This observational study used data from the Danish Colorectal Cancer Screening Database. Sensitivity and specificity were estimated for various cut-off values based on a large number of cancers. Traditionally optimal cut-off values are found by weighting sensitivity and specificity equally. As this might result in too many unnecessary colonoscopies we also provide optimal cut-off values for different weighting of sensitivity and specificity/number of needed colonoscopies to detect one cancer.RESULTS: Weighting sensitivity and specificity equally gives an optimal cut-off value of 45 ng Hb/ml. This, however, means making 24 colonoscopies to detect one cancer. Weighting sensitivity lower and for example, aiming at making about 16 colonoscopies to detect one cancer, gives an optimal cut-off value of 125 ng Hb/ml.CONCLUSIONS: The optimal cut-off value in an FIT population-based screening program is 45 ng Hb/ml, when as traditionally sensitivity and specificity are weighted equally. If, however, 24 colonoscopies needed to detect one cancer is too huge a burden on the health care system and the participants, 80, 125, 175, and 350 ng Hb/ml are optimal cut-off values when only 19/16/14/10 colonoscopies are accepted to find one cancer.
U2 - 10.1002/cam4.3761
DO - 10.1002/cam4.3761
M3 - Journal article
C2 - 33534955
VL - 10
SP - 1872
EP - 1879
JO - Cancer Medicine
JF - Cancer Medicine
SN - 2045-7634
IS - 5
ER -
ID: 258341586