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. 2017 Apr;5(3):448-454.
doi: 10.1177/2050640616659998. Epub 2016 Jul 14.

Fecal immunochemical test-based colorectal cancer screening: The gender dilemma

Esmée J Grobbee  1 , Els Wieten  1 , Bettina E Hansen  1 , Esther M Stoop  1 , Thomas R de Wijkerslooth  2 , Iris Lansdorp-Vogelaar  3 , Patrick M Bossuyt  4 , Evelien Dekker  2 , Ernst J Kuipers  1 , Manon Cw Spaander  1
Affiliations

Fecal immunochemical test-based colorectal cancer screening: The gender dilemma

Esmée J Grobbee et al. United European Gastroenterol J. 2017 Apr.

Abstract

Background: Despite differences between men and women in incidence of colorectal cancer (CRC) and its precursors, screening programs consistently use the same strategy for both genders.

Objective: The objective of this article is to illustrate the effects of gender-tailored screening, including the effects on miss rates of advanced neoplasia (AN).

Methods: Participants (age 50-75 years) in a colonoscopy screening program were asked to complete a fecal immunochemical test (FIT) before colonoscopy. Positivity rates, sensitivity and specificity for detection of AN at multiple cut-offs were determined. Absolute numbers of detected and missed AN per 1000 screenees were calculated.

Results: In total 1,256 individuals underwent FIT and colonoscopy, 51% male (median age 61 years; IQR 56-66) and 49% female (median age 60 years; IQR 55-65). At all cut-offs men had higher positivity rates than women, ranging from 3.8% to 10.8% versus 3.2% to 4.8%. Sensitivity for AN was higher in men than women; 40%-25% and 35%-22%, respectively. More AN were found and missed in absolute numbers in men at all cut-offs.

Conclusion: More AN were both detected and missed in men compared to women at all cut-offs. Gender-tailored cut-offs could either level sensitivity in men and women (i.e., lower cut-off in women) or level the amount of missed lesions (i.e., lower cut-off in men).

Keywords: Colorectal cancer; fecal immunochemical test; gender; miss rates; screening.

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Figures

Figure 1.
Figure 1.
Sensitivity and specificity for men and women for all cut-offs ranging from 0 to 100 μg Hb/g feces.
Figure 2.
Figure 2.
(a) Detected advanced neoplasia per 1000 screenees (for 100% participation in absolute numbers). (b) Missed advanced neoplasia per 1000 screenees (for 100% participation in absolute numbers).
See this image and copyright information in PMC

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