Consistent Major Differences in Sex- and Age-Specific Diagnostic Performance among Nine Faecal Immunochemical Tests Used for Colorectal Cancer Screening

Simple Summary We evaluated the performance of nine faecal immunochemical tests among participants of screening colonoscopy. A total of 216 cases of advanced neoplasia (AN, colorectal cancer or advanced adenoma) and 300 randomly selected participants without AN were included. Diagnostic performance for detection of AN was assessed by sex and age (50-64 vs. 65-79 years), for each of the nine faecal immunochemical tests (FITs) individually and for all FITs combined. Major differences in diagnostic performance by sex and age were consistently seen across nine different FIT brands. Sensitivities were consistently lower, and specificities were consistently higher, for females as compared with males. Positive predictive values were similar between both sexes, but negative predictive values were higher for females. A negative FIT is less reliable in ruling out AN among men than among women and among older than among younger participants. Evidence on diagnostic performance of faecal immunochemical tests (FITs) by sex and age is scarce. We aimed to evaluate FIT performance for detection of advanced colorectal neoplasia (AN) by sex and age across nine different FIT brands in a colonoscopy-controlled setting. The faecal samples were obtained from 2042 participants of colonoscopy screening. All eligible cases with AN (n = 216) and 300 randomly selected participants without AN were included. Diagnostic performance for detection of AN was assessed by sex and age (50-64 vs. 65-79 years for each of the nine FITs individually and for all FITs combined. Sensitivity was consistently lower, and specificity was consistently higher for females as compared with males (pooled values at original FIT cutoffs, 25.7% vs. 34.6%, p = 0.12 and 96.2% vs. 90.8%, p < 0.01, respectively). Positive predictive values (PPVs) were similar between both sexes, but negative predictive values (NPVs) were consistently higher for females (pooled values, 91.8% vs. 86.6%, p < 0.01). Sex-specific cutoffs attenuated differences in sensitivities but increased differences in predictive values. According to age, sensitivities and specificities were similar, whereas PPVs were consistently lower and NPVs were consistently higher for the younger participants. A negative FIT is less reliable in ruling out AN among men than among women and among older than among younger participants. Comparisons of measures of diagnostic performance among studies with different sex or age distributions should be interpreted with caution.

Automated summary

This study evaluated the performance of nine fecal immunochemical tests in screening colonoscopy participants, with differences in diagnostic performance observed by sex and age. Females consistently showed lower sensitivities and higher specificities than males, with higher negative predictive values. A negative FIT was found to be less reliable in ruling out AN among men and older participants than among women and younger participants.