Addition of an online, validated family history questionnaire to the Dutch FIT-based screening programme did not improve its diagnostic yield

Victorine H Roos, Frank G J Kallenberg, Manon van der Vlugt, Evelien J C Bongers, Cora M Aalfs, Patrick M M Bossuyt, Evelien Dekker, Victorine H Roos, Frank G J Kallenberg, Manon van der Vlugt, Evelien J C Bongers, Cora M Aalfs, Patrick M M Bossuyt, Evelien Dekker

Abstract

Background: Faecal immunochemical testing (FIT) is suboptimal in detecting advanced neoplasia (AN). To increase the sensitivity and yield of a FIT-based screening programme, FIT could be combined with risk factors for AN. We evaluated the incremental yield of adding a family history questionnaire (FHQ) on colorectal cancer (CRC) and Lynch syndrome-associated tumours to the Dutch FIT-based screening programme.

Methods: Six thousand screen-naive individuals, aged 59-75 years, were invited to complete a FIT (FOB-Gold, cut-off 47 µg Hb/g faeces) and a validated online FHQ. Participants with a positive FIT and/or positive FHQ, confirmed after genetic counselling, were referred for colonoscopy. Yield of detecting AN per 1000 invitees for the combined strategy was compared with the FIT-only strategy.

Results: Of the 5979 invitees, 1952 (32.6%) completed the FIT only, 2379 (39.8%) completed both the FIT and FHQ and 95 (1.6%) completed the FHQ only. Addition of the FHQ to FIT-based screening resulted in one extra case of AN detected after 16 additional colonoscopies, resulting in a yield of 19.6 (95% CI, 16.4-23.5) for the combined strategy versus 19.5 (95% CI, 16.3-23.3) for the FIT-only strategy (p = 1.0).

Conclusions: The addition of an FHQ to one round of FIT screening did not increase the detection of AN compared with FIT only (ClinicalTrials.gov NCT02698462).

Conflict of interest statement

E.D. has an endoscopic equipment on loan from FujiFilm and receives a research grant from FujiFilm. He has received a honorarium for consultancy from FujiFilm, Olympus, Tillots, GI Supply and CPP-FAP and a speakers’ fee from Olympus, Roche and GI Supply. Also he is on the supervisory board of eNose. The other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study population.
Fig. 2
Fig. 2
Study enrollment.
Fig. 3
Fig. 3
Genetic counselling results.

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