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Risk-adjusted colorectal cancer screening using the FIT and routine screening data : development of a risk prediction model
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Cooper, Jennifer Anne, Parsons, Nicholas R., Stinton, Chris, Mathews, Christopher, Smith, Steve, Halloran, Stephen P., Moss, Sue and Taylor-Phillips, Sian (2017) Risk-adjusted colorectal cancer screening using the FIT and routine screening data : development of a risk prediction model. British Journal of Cancer . doi:10.1038/bjc.2017.375 ISSN 0007-0920.
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WRAP-colorectal-cancer-screening-FIT-screening-data-risk-prediction-model-Cooper-Taylor-Phillips-2017.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial-Share Alike 4.0. Download (1539Kb) | Preview |
Official URL: http://dx.doi.org/10.1038/bjc.2017.375
Abstract
Background:
The faecal immunochemical test (FIT) is replacing the guaiac faecal occult blood test in colorectal cancer screening. Increased uptake and FIT positivity will challenge colonoscopy services. We developed a risk prediction model combining routine screening data with FIT concentration to improve the accuracy of screening referrals.
Methods:
Multivariate analysis used complete cases of those with a positive FIT (⩾20 μg g−1) and diagnostic outcome (n=1810; 549 cancers and advanced adenomas). Logistic regression was used to develop a risk prediction model using the FIT result and screening data: age, sex and previous screening history. The model was developed further using a feedforward neural network. Model performance was assessed by discrimination and calibration, and test accuracy was investigated using clinical sensitivity, specificity and receiver operating characteristic curves.
Results:
Discrimination improved from 0.628 with just FIT to 0.659 with the risk-adjusted model (P=0.01). Calibration using the Hosmer–Lemeshow test was 0.90 for the risk-adjusted model. The sensitivity improved from 30.78% to 33.15% at similar specificity (FIT threshold of 160 μg g−1). The neural network further improved model performance and test accuracy.
Conclusions:
Combining routinely available risk predictors with the FIT improves the clinical sensitivity of the FIT with an increase in the diagnostic yield of high-risk adenomas.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Colon (Anatomy) -- Cancer -- Diagnosis, Rectum -- Cancer -- Diagnosis, Medical screening -- Quality control | ||||||
| Journal or Publication Title: | British Journal of Cancer | ||||||
| Publisher: | Nature Publishing Group | ||||||
| ISSN: | 0007-0920 | ||||||
| Official Date: | 2 November 2017 | ||||||
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| DOI: | 10.1038/bjc.2017.375 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 22 November 2017 | ||||||
| Date of first compliant Open Access: | 22 November 2017 | ||||||
| RIOXX Funder/Project Grant: |
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