Most European countries that screen for colorectal cancer use the faecal immunochemical test (FIT). In Finland, this was piloted in a screening programme where the cut-off point for a positive test result was set differently for women and men. A study published in the peer-reviewed open access medical journal BMJ Open finds that this equalises the gaps in screening performance between sexes.
FIT-based colorectal cancer screening may suit all sexes better than gFOBT screening, according to a Finnish Cancer Registry study.
In 2022, Finland will launch a national colorectal cancer screening programme based on a two-yearly FIT test to check the blood content of a stool sample. To verify the feasibility and performance of the planned programme, a screening pilot phase has been run in the country since 2019. Previous colorectal cancer screening in Finland was carried out in a research setting using the guaiac faecal occult blood test (gFOBT).
“The difference between FIT and gFOBT screening is that FIT detects human blood, which means that no dietary restrictions are required before the screening test,” says Tytti Sarkeala, Director of Screening at the Finnish Cancer Registry. “In addition, the FIT test requires only one sample and is easy to take.”
Europe needs research on scope to influence effectiveness differences
The FIT test is currently the most widely used screening method in Europe. In Finland, the screening programme aims to be run in such a way that it works as well as possible for all sexes. Previous studies on gFOBT screening have found that men benefit more from colorectal cancer screening than women; thus, for instance, the cut-offs for a positive FIT test result are being set differently for women and men. Sweden is the only other country in Europe to have previously used a similar strategy.
“More adenomas and cancers can be expected to be found in men than in women, because men have a higher cancer detection rate,” says Sarkeala. “But the difference in screening performance with the gFOBT test was much larger than the gender difference in background risk. In our results, the gap in findings and referral rates narrowed, but screening did not yet work optimally among men, so the cut-off for men was lowered in 2020. Our study suggests that FIT screening may work better than gFOBT screening for all sexes.”
In Finland, the data on the feasibility and performance of FIT screening will allow further fine-tuning of the screening programme, so that national screening can start in the most favourable circumstances.
Finns actively attend colorectal cancer screening
The study sheds more light on the design of Finland's colorectal cancer screening programme and the results of the first pilot year of screening. Easy at-home screening for colorectal cancer has been enthusiastically received by Finns: in the first year, the average screening participation rose to 79%.
“Women are clearly more eager than men to return the screening test. In the first year of screening, the participation rate was 83% for women and 75% for men,” says Sarkeala.
For colorectal cancer screening, two reminders were sent out after the first invitation letter, if the invitee had not returned the sample. Two reminder rounds seemed to improve the overall participation significantly, from 54 % to 79 %.
Contact:
Tytti Sarkeala, Director of Screening at the Finnish Cancer Registry, +358 50 411 4238, [email protected]
Nina Airisto, Communications Specialis at the Finnish Cancer Registry, +358 50 562 5760, [email protected]
Full citation: Tytti Sarkeala, Martti Färkkilä, Ahti Anttila, Marja Hyöty, Matti Kairaluoma, Tero Rautio, Markku Voutilainen, Sanni Helander, Maija Jäntti, Milla Lehtinen, Lotta Patrikka, Nea Malila, Sirpa Heinävaara (2021) Piloting gender-oriented colorectal cancer screening with a fecal immunochemical test – population-based registry study from Finland, BMJ Open 2021, DOI: 10.1136/bmjopen-2020-046667
URL: http://bmjopen.bmj.com/cgi/content/full/bmjopen-2020-046667
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