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Canadian Journal of Gastroenterology and Hepatology
Volume 2016, Article ID 5914048, 5 pages
Research Article

Comparison of One versus Two Fecal Immunochemical Tests in the Detection of Colorectal Neoplasia in a Population-Based Colorectal Cancer Screening Program

1Division of Gastroenterology & Hepatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
2British Columbia Cancer Agency, Colon Screening Program, Hereditary Cancer Program, University of British Columbia, Vancouver, BC, Canada

Received 28 March 2016; Accepted 18 October 2016

Academic Editor: Michael Beyak

Copyright © 2016 Sarvenaz Moosavi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. To determine the positive predictive value (PPV) of two versus one abnormal FIT in the detection of colorectal neoplasia in a Canadian population. Methods. Three communities enrolled in a colorectal cancer (CRC) screening pilot program from 01/2009 to 04/2013 using 2 FITs. Data collected included demographics, colonoscopy, pathology, and FIT results. Participants completed both FITs and had one positive FIT and colonoscopy. PPV of one versus two abnormal FITs was calculated using a weighted-generalized score statistic. A two-sided 5% significance level was used. Results. 1576 of 17,031 average-risk participants, 50–75 years old, had a positive FIT. Colonoscopy revealed 58 (3.7%) cancers, 419 (31.6%) high-risk polyps, and 374 (23.7%) low-risk polyps as the most significant lesion. PPV of one versus two positive FITs for cancer, high-risk polyps, and any neoplasia were 1% versus 8%, 20% versus 40%, and 48% versus 67%, respectively ( value < 0.0001). When the first FIT was negative, the second positive FIT detected 7 CRCs and 98 high-risk polyps. Conclusions. PPV of two positive FITs is superior to one positive FIT for CRC and high-risk polyps. The added value of the second FIT was 12% of total CRCs and 23% of total high-risk polyps.