Article Figures & Data
Tables
- Table 1.
Definition of repeat FOBT outcomes across studies.
Outcome Screening rounds Numerator Denominator Key example Proportion of Round 1 participants who completed repeat FOBT in Round 2 2 Completed FOBT in Round 2 Completed FOBT with negative result in Round 1 Baker, 2015 (26) Proportion of patients who completed two, consecutive FOBT 2 Completed consecutive FOBT in Rounds 1 and 2 Eligible to complete FOBT in two screening rounds; negative result or did not complete FOBT in Round 1 Singal, 2018 (20) Proportion of patients who completed FOBT in all screening rounds ≥3 Completed FOBT in all screening rounds Eligible to complete FOBT in three or more screening rounds; negative result or did not complete FOBT in all but final round Denis, 2015 (48) - Table 2.
Characteristics of included studies (n = 27 unique studies reported in 35 articles).
Author, year Study setting Eligibility criteria Sample size FOBT/FIT Screening delivery Tazi, 1997 (40) Burgundy, France Age 45–74 years 45,642 Biennial Mailed outreach 1988–1996 Population-based Weller, 2007 (39) UK Colorectal Cancer Screening Pilot Evaluation, England Age 50–69 years; completed negative index test 107,434 BiennialHema-screen Mailed outreachPopulation-based 2000–2004 Fenton, 2010 (16) Group Health Cooperative, Seattle, WA Age 52–78 years; completed negative index test; continuously enrolled in health plan 10,132 Biennial Opportunistic 2000–2003 Hemoccult II SENSA Janda, 2010 (38) Queensland, Australia Age 50–74 years; completed negative index test 3,406 Biennial Mailed outreach 2000–2002 Excluded hx SIG or COL Population-based Gellad, 2011 (51) Veterans Health Administration (136 sites), USA Age 50–75 years 394,996 Annual Opportunistic 1999–2005 Excluded hx SIG, COL, or colorectal cancer Cole, 2012 (27) National Bowel Cancer Screening Pilot Program, Australia Age 55–74 years 16,433 AnnualDetect Mailed outreach 2003–2005 Population-based Crotta, 2012 (50) Aosta Valley, Italy Age 50–74 years 2,959 Biennial Mailed outreach 2001–2008 Excluded hx SIG, COL, IBD, polyps, colorectal cancer, or severe comorbid conditions OC-Sensor Population-based Garcia, 2012 (37) Catalonia, Spain Age 50–69 years; completed negative index test 11,969 Biennial Mailed outreach 2004–2006 Population-based Liss, 2013 (35) Erie Family FQHC, Chicago, IL Age 50–74 years; completed negative index test 281 Annual Opportunistic 2010–2011 Excluded hx SIG, COL, IBD, colorectal cancer, or lower GI symptoms Bae, 2014 (25) University Hospital at Gangdong, South Korea Age ≥50 years; completed ≥1 FOBT in prior decade; completed baseline survey 237 Biennial Opportunistic 2002–2011 Baker, 2014 (36) Erie Family FQHC, Chicago, IL Age 51–75 years; completed negative index test 225 Annual Opportunistic 2010–2011 Excluded hx SIG, COL, IBD, or lower GI symptoms OC-Light Baker, 2014 (36) Erie Family FQHC, Chicago, IL Age 51–75 years; completed negative index test 225 Annual Mailed outreach 2010–2011 Excluded hx SIG, COL, IBD, or lower GI symptoms OC-Light Duncan, 2014 (49) Bowel Health Service, Australia Age 50–75 years; completed baseline survey 1,540 Annual Mailed outreach 2008–2010 Excluded hx SIG, COL, IBD, or colorectal cancer, family hx colorectal cancer OC-Sensor Population-based McNamara, 2014 (28) Tallaght Hospital-Trinity College Colorectal Cancer Screening Program, Ireland Age 50–75 yearsExcluded hx COL, serious illness, or colorectal cancer 9,863 BiennialOC-Sensor Mailed outreach 2008–2012 Steele, 2014 (34) UK Colorectal Cancer Screening Pilot Evaluation, Scotland Age 50–69 years 251,578 BiennialHema-screen Mailed outreachPopulation-based 2000–2006 Wong, 2014 (30); Wong, 2013 (31) Hong Kong Age 50–70 years 5,832 Annual Mailed outreach 2008–2012 Excluded hx SIG, COL, IBD, colorectal cancer, or lower GI symptoms Hemosure Population-based Baker, 2015 (26) Erie Family FQHC, Chicago, IL Age 51–75 years; completed negative index test 225 Annual Mailed outreach 2012–2013 Excluded hx SIG, COL, or colorectal cancer in Round 1 OC-Light Bujanda, 2015 (33) Basque, Spain Age 50–69 years; completed negative index test 100,135 Biennial Mailed outreach 2009–2013 Excluded hx SIG, COL, IBD, or colorectal cancer, family hx colorectal cancer OC-Sensor Population-based Denis, 2015 (48); Pornet, 2014 (52) Haut-Rhin, France Age 50–74 years 242,271 Biennial Mailed outreach 2003–2012 Excluded hx of SIG, COL, serious illness, or high-risk colorectal cancer features Hemoccult II Population-based Lo, 2015 (29); Lo, 2016 (72); Lo, 2015 (73) NHS Bowel Cancer Screening Program, England Age 60–64 years 62,099 BiennialHema-screen Mailed outreachPopulation-based 2006–2012 Schlichting, 2015 (32) Veterans Health Administration, Iowa City, IA Age <65 years; completed negative index testExcluded self-reported screen up-to-date 159 AnnualOC FIT-CHEK Mailed outreach 2011–2013 Paszat, 2016 (43) ColonCancerCheck Program, Ontario, Canada Age 50–74 years; completed negative index test 294,329 Biennial Opportunistic 2008–2012 Excluded hx SIG, COL, or colorectal cancer, family hx colorectal cancer Hema-Screen Telford, 2016 (42) Colon Check Program, British Columbia, Canada Age 50–74 16,234 Biennial Mailed outreach 2009–2013 Excluded hx SIG, COL, colorectal cancer, IBD, or rectal bleeding OC-Auto Micro Population-based Knudsen, 2017 (41) Bowel Cancer Screening in Norway, Southeast Norway Age 50–74 years; completed negative index test; completed lifestyle survey 3,114 Biennial Mailed outreachPopulation-based 2012–2016 Excluded hx SIG, COL, or colorectal cancer Saraste, 2017 (45) Stockholm-Gotland Region, Sweden Age 60–69 years; invited to ≥3 screening rounds 48,959 Biennial Hemoccult Mailed outreach 2008–2015 Population-based Singal, 2017 (47) Parkland Health & Hospital System, Dallas, TX Age 50–64 years; not up-to-date with screening Excluded hx SIG, COL, colorectal cancer, or IBD 1,199 Annual Opportunistic 2013–2016 Hemoccult ICT Singal, 2017 (47) Parkland Health & Hospital System, Dallas, TX Age 50–64 years; not up-to-date with screening Excluded hx SIG, COL, colorectal cancer, or IBD 2,400 Annual Mailed outreach 2013–2016 FIT-CHEK van der Vlugt, 2017 (47); Southwest and Northwest Netherlands Age 50–74 years; eligible for ≥2 screening rounds 17,132 Biennial Mailed outreach Denters, 2013 (74); Grobbee, 2017 (75) 2006–2014 Excluded hx SIG, COL, IBD, colorectal cancer, or severe comorbid conditions OC-Sensor Population-based Singal, 2018 (20); Jensen, 2016 (6); Gordon, 2015 (21) Parkland Health & Hospital System, Dallas, TX; Kaiser Permanente Washington, Seattle, WA; Kaiser Permanente Northern and Southern California Age 50–71 years; completed negative index test; 2–3 years follow-upExcluded hx SIG, COL, or colorectal cancer 273,182 Varied across sites Varied across sites 2010–2013 Singal, 2018 (20); Jensen, 2016 (6); Gordon, 2015 (21) Parkland Health & Hospital System, Dallas, TX; Kaiser Permanente Washington, Seattle, WA; Kaiser Permanente Northern and Southern California Age 50–71 years; completed negative index test; ≥3 years follow-upExcluded hx SIG, COL, or colorectal cancer 344,103 Varied across sites Varied across sites 2010–2013 Abbreviations: COL, colonoscopy; GI, gastrointestinal; hx, history; IBD, irritable bowel disease; SIG, sigmoidoscopy.
- Table 3.
Prevalence of repeat FOBT across studies (n = 27 unique studies reported in 35 articles) by screening delivery.
Author, year Data source Screening rounds Relevant outcome Sample size Prevalence (95% CI) Mailed outreach, population-based Tazi, 1997 (40) Population registry 5 % completed among Round 1 participants 36,573/43,852 83.4% (83.1%–83.7%) % completed across all screening rounds 13,951/37,502 37.2% (36.7%–37.7%) Weller, 2007 (39) Government health plan 2 % completed among Round 1 participants 87,129/107,434 81.1% (80.9%–81.3%) Janda, 2010 (38) Population registry 2 % completed among Round 1 participants 874/1,163 75.2% (72.7%–77.6%) % completed two, consecutive tests 874/3,406 25.7% (24.2%–27.1%) Cole, 2012 (27) Government health plan 2 % completed among Round 1 participants 6,656/8,345 79.8% (78.9%–80.6%) % completed two, consecutive tests 6,656/16,433 40.5% (39.8%–41.3%) Crotta, 2012 (50) Population registry 4 % completed across all screening rounds 713/2,109 33.8% (31.8%–35.8%) Garcia, 2012 (37) Population registry 2 % completed among Round 1 participants 10,415/11,969 87.0% (86.4%–87.6%) % completed two, consecutive tests 10,415/63,685 16.4% (16.1%–16.6%) Duncan, 2014 (49) Government health plan 3 % completed across all screening rounds 860/1,540 55.8% (53.4%–58.3%) Steele, 2014 (34) Government health plan 3 % completed among Round 1 participants 114,063/139,274 81.9% (81.7%–82.1%) % completed two, consecutive tests 114,063/251,578 45.3% (45.1%–45.5%) % completed across all screening rounds 98,494/251,578 39.2% (39.0%–39.3%) Denis, 2015 (48); Pornet, 2014 (52) Government health plan 4 % completed across all screening rounds 34,556/242,271 14.3% (14.1%–14.4%) Wong, 2014 (30); Wong, 2013 (31) Government health plan 3 % completed among Round 1 participants 4,426/5,391 82.1% (81.1%–83.1%) % completed two, consecutive tests 4,426/5,534 80.0% (78.9%–81.0%) % completed across all screening rounds 3,519/5,488 64.1% (62.9%–65.4%) Bujanda, 2015 (33) Government health plan 2 % completed among Round 1 participants 69,193/100,135 69.1% (68.8%–69.4%) Lo, 2015 (29); Lo, 2016 (72); Lo, 2015 (73) Government health plan 3 % completed among Round 1 participants 30,182/35,611 84.8% (84.4%–85.1%) % completed two, consecutive tests 30,182/62,099 48.6% (48.2%–49.0%) % completed across all screening rounds 27,587/62,099 44.4% (44.0%–44.8%) Telford, 2016 (42) Population registry 2 % completed among Round 1 participants 5,378/6,255 86.0% (85.1%–86.8%) Knudsen, 2017 (41) Population registry 2 % completed among Round 1 participants 2,574/3,114 82.7% (81.3%–84.0%) Saraste, 2017 (45) Population registry 3 % completed among Round 1 participants 26,098/29,113 89.6% (89.3%–90.0%) % completed two, consecutive tests 26,098/48,959 53.3% (52.9%–53.7%) % completed across all screening rounds 24,373/48,959 49.8% (49.3%–50.2%) van der Vlugt, 2017 (47); Denters, 2013 (74); Grobbee, 2017 (75) Population registry 4 % completed two, consecutive tests 2,561/5,232 48.9% (47.6%–50.3%) % completed across all screening rounds 4,345/8,795 49.4% (48.4%–50.4%) % completed in 3 of 3 screening rounds 1,365/3,285 41.6% (39.9%–43.2%) Mailed outreach, integrated health care systems Baker (intervention), 2014 (36) EHR 2 % completed among Round 1 participants 185/219 84.5% (79.7%–89.3%) McNamara, 2014 (28) EHR 2 % completed among Round 1 participants 3,767/4,549 82.8% (81.7%–83.9%) % completed two, consecutive tests 3,767/9,359 40.3% (39.3%–41.2%) Baker, 2015 (26) EHR 2 % completed among Round 1 participants 114/129 88.4% (82.8%–93.9%) % completed two, consecutive tests 114/189 60.3% (53.3%–67.3%) Schlichting, 2015 (32) EHR 2 % completed among Round 1 participants 126/159 79.2% (72.9%–85.5%) Singal (intervention), 2017 (47) EHR 3 % completed across all screening rounds 395/2,007 19.7% (17.9%–21.4%) Opportunistic Fenton, 2010 (16) EHR 2 % completed among Round 1 participants 4,928/10,132 48.6% (47.7%–49.6%) Gellad, 2011 (51) EHR 5 % completed in 4 of 5 screening rounds 55,652/394,996 14.1% (14.0%–14.2%) Liss, 2013 (35) EHR 2 % completed among Round 1 participants 69/281 24.6% (19.5%–29.6%) Bae, 2014 (25) Self-report 5 % completed across all screening rounds 105/237 44.3% (38.0%–50.6%) Baker (usual care), 2014 (36) EHR 2 % completed among Round 1 participants 84/219 38.3% (31.9%–44.8%) Paszat, 2016 (43) Government health plan 2 % completed among Round 1 participants 101,526/294,329 34.5% (34.3%–34.7%) Singal (usual care), 2017 (47) EHR 3 % completed across all screening rounds 8/1,044 0.8% (0.2%–1.3%)
Varied Singal, 2018 (20); Jensen, 2016 (6); Gordon, 2015 (21) EHR 2 % completed two, consecutive tests 127,188/273,182 46.6% (46.4%–46.7%) Singal, 2018 (20); Jensen, 2016 (6); Gordon, 2015 (21) EHR 3 % completed two, consecutive tests 160,252/344,103 46.6% (46.4%–46.7%) Note: For studies with three or more screening rounds (e.g., Saraste, 2017; ref. 45), the outcome describing completion of two, consecutive tests corresponds to FOBT completion in the first two screening rounds (i.e., in Rounds 1 and 2); confidence intervals estimated using Wald method based on a normal approximation.Abbreviation: EHR, electronic health records.
- Table 4.
Proposed checklist for reporting studies of repeat stool-based screening.
Outcome variable • Explicitly defined, with numerator and denominator Test characteristics • Test name, manufacturer • Quantitative or qualitative • Number of samples • Cutoff concentration Study population • Age at study entry • Number with high-risk features: family history, personal history, IBD, or UC • Proportion previously screened Screening round • Number of screening rounds • Follow-up period • Distinguish new invitees from previous participants • Number ineligible: positive FOBT or diagnostic colonoscopy in prior screening round, aged out, moved away from health care system or geographic region, colonoscopy for other reason, colorectal cancer diagnosis, death Screening delivery • Organized outreach versus opportunistic • Frequency, timing, and intensity of patient reminders • Patient education materials (if any) • Out-of-pocket costs or financial incentives Abbreviations: IBD, inflammatory bowel disease; UC, ulcerative colitis.
Additional Files
Supplementary Data
- Supplementary Table 1 - Completeness of reporting across categories of representativeness, intervention, outcome ascertainment, follow-up, and eligibility
- Supplementary Figure 1 - Supplementary Figure 1. PRISMA flow diagram: selection of systematic review.
- Supplementary Figure 2 - Supplementary Figure 2. Prevalence of repeat FOBT in Round 2 among those completing in Round 1, by screening delivery (mailed outreach vs. opportunistic.)
- Supplementary Figure 3 - Supplementary Figure 3. Prevalence of repeat FOBT in Round 2 among those completing in Round 1, by screening interval (annual vs. biennial.)
- Supplementary Figure 4 - Supplementary Figure 4. Prevalence of repeat FOBT in Round 2 among those completing in Round 1, by test type (FIT vs. gFOBT.)
- Supplementary Materials and Methods - Supplementary Material: search strategies for MEDLINE, Embase, and Cochrane Library.
February 2020
Volume 29, Issue 2
Volume 29, Issue 2
A Systematic Review of Repeat Fecal Occult Blood Tests for Colorectal Cancer Screening
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