Imperial College London
Portrait Picture

Professor Amanda Cross

Faculty of Medicine, School of Public Health

Professor of Cancer Epidemiology
 
 
 
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Contact

 

+44 (0)20 7594 3338amanda.cross

 
 
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Assistant

 

Mr Will Kay +44 (0)20 7594 3350

 
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Location

 

Room 1089Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Cross:2019:10.1136/gutjnl-2018-317297,
author = {Cross, A and Wooldrage, K and Robbins, E and Kralj-Hans, I and MacRae, E and Piggott, C and Stenson, I and Prendergast, A and Patel, B and Pack, K and Howe, R and Swart, N and Snowball, J and Duffy, SW and Morris, S and von, Wagner C and Halloran, S and Atkin, W},
doi = {10.1136/gutjnl-2018-317297},
journal = {Gut},
pages = {1642--1652},
title = {Faecal immunochemical tests (FIT) versus colonoscopy for surveillance after screening and polypectomy: a diagnostic accuracy and cost-effectiveness study},
url = {http://dx.doi.org/10.1136/gutjnl-2018-317297},
volume = {68},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objective The English Bowel Cancer Screening Programme (BCSP) recommends 3 yearly colonoscopy surveillance for patients at intermediate risk of colorectal cancer (CRC) postpolypectomy (those with three to four small adenomas or one ≥10 mm). We investigated whether faecal immunochemical tests (FITs) could reduce surveillance burden on patients and endoscopy services.Design Intermediate-risk patients (60–72 years) recommended 3 yearly surveillance were recruited within the BCSP (January 2012–December 2013). FITs were offered at 1, 2 and 3 years postpolypectomy. Invitees consenting and returning a year 1 FIT were included. Participants testing positive (haemoglobin ≥40 µg/g) at years one or two were offered colonoscopy early; all others were offered colonoscopy at 3 years. Diagnostic accuracy for CRC and advanced adenomas (AAs) was estimated considering multiple tests and thresholds. We calculated incremental costs per additional AA and CRC detected by colonoscopy versus FIT surveillance.Results 74% (5938/8009) of invitees were included in our study having participated at year 1. Of these, 97% returned FITs at years 2 and 3. Three-year cumulative positivity was 13% at the 40 µg/g haemoglobin threshold and 29% at 10 µg/g. 29 participants were diagnosed with CRC and 446 with AAs. Three-year programme sensitivities for CRC and AAs were, respectively, 59% and 33% at 40 µg/g, and 72% and 57% at 10 µg/g. Incremental costs per additional AA and CRC detected by colonoscopy versus FIT (40 µg/g) surveillance were £7354 and £180 778, respectively.Conclusions Replacing 3 yearly colonoscopy surveillance in intermediate-risk patients with annual FIT could reduce colonoscopies by 71%, significantly cut costs but could miss 30%–40% of CRCs and 40%–70% of AAs.
AU  - Cross,A
AU  - Wooldrage,K
AU  - Robbins,E
AU  - Kralj-Hans,I
AU  - MacRae,E
AU  - Piggott,C
AU  - Stenson,I
AU  - Prendergast,A
AU  - Patel,B
AU  - Pack,K
AU  - Howe,R
AU  - Swart,N
AU  - Snowball,J
AU  - Duffy,SW
AU  - Morris,S
AU  - von,Wagner C
AU  - Halloran,S
AU  - Atkin,W
DO  - 10.1136/gutjnl-2018-317297
EP  - 1652
PY  - 2019///
SN  - 0017-5749
SP  - 1642
TI  - Faecal immunochemical tests (FIT) versus colonoscopy for surveillance after screening and polypectomy: a diagnostic accuracy and cost-effectiveness study
T2  - Gut
UR  - http://dx.doi.org/10.1136/gutjnl-2018-317297
UR  - http://hdl.handle.net/10044/1/66516
VL  - 68
ER  -
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