By Will Boggs MD
NEW YORK (Reuters Health) - 28/3/2019
Two brands of fecal immunochemical tests (FITs), FOB-Gold and OC-Sensor, are associated with similar colorectal cancer (CRC) screening participation despite small differences in ease of use, Dutch researchers report.
"We showed within the CRC screening program that some preferences for one test do not affect participation (and in previous studies that detection is equivalent)," Dr. Clasine M. de Klerk of the University of Amsterdam told Reuters Health by email. "This practically means that the decision on which FIT should be implemented can be based on other reasons, such as easy laboratory processing, logistics, and costs."
The FIT is currently recommended in European guidelines as the test of choice for CRC population screening. Whether differences between FIT brands could affect participation remains unclear.
Dr. de Klerk and colleagues earlier showed that the accuracy in detecting advanced neoplasia is comparable for OC-Sensor and FOB-Gold. In the current study, they surveyed more than 21,000 screening invitees regarding ease of use and preference of FIT brand and, in a randomized study, compared participation rates and proportions of nonanalyzable tests between these two brands.
Except for the clarity of instructions for opening the test, all aspects of ease of use (opening the test, using the test with the stick, replacing the stick in the tube, closing the test with the, and sampling instructions) favored FOB-Gold, although differences were small, the researchers report in the American Journal of Gastroenterology, February 14.
More participants preferred FOB-Gold (36%) than OC-Sensor (5%), but most participants (59%) did not express a clear preference for either brand.
Those who preferred FOB-Gold cited the wider opening of the tube, the easier opening and closing screw, and the method of sampling the stool as primary reasons.
Those who referred OC-Sensor cited its better grip, easier closing, single cap that avoids confusion on which cap to open, and its flat shape to prevent the test from rolling away before and after sampling. Participation rates did not differ significantly between invitees allocated to receive FOB-Gold (48.7%) and those allocated to receive OC-Sensor (48.9%). The same was true of nonanalyzability rates (0.1% vs. 0.4%, respectively).
"Just implementing a CRC screening program is not enough; its effect on its invitees should be continuously monitored and assessed for improvements," Dr. de Klerk said. "Our research is an example that can be used more often: implementing research with high methodological quality alongside a screening program. This allows for up-to-date data on many research questions in the population and setting of interest and, therefore, allows for improvements where possible. This should be a responsibility for inviting 'healthy' persons to be part of a (although small) medical intervention."
Dr. James Allison of the University of California, San Francisco, who has studied various aspects of CRC screening, told Reuters Health by email, "Patient acceptance is very important for success of screening programs, and this study is an example of what should be done to investigate it. The best screening test there is will not be a success if no one or just small numbers use them. In the Spanish randomized controlled trial of FIT versus colonoscopy, more potential screenees showed up for their FIT tests than showed up for their colonoscopy. As a result, the same number of cancers was found in each group."
"Acceptance in a Dutch population may be very different from a diverse American population like San Francisco or Oakland or a more homogenous population in Iowa," he said. "The authors do discuss the issue of diversity in their population and how that could affect results. It didn't seem to affect them, but that doesn't mean it wouldn't in an American population."
Am J Gastroenterol 2019.