An Exploratory Analysis of Fecal Immunochemical Test Performance for Colorectal Cancer Screening in Nigeria

Gregory C. Knapp, Avinash Sharma, Bolatito Olopade, Olusegun I. Alatise, Olalekan Olasehinde, Olujide O. Arije, Philip E. Castle, T. Peter Kingham

Research output: Contribution to journalArticle

Abstract

Introduction: The fecal immunochemical test (FIT) for hemoglobin is recommended for colorectal cancer (CRC) screening in resource-limited environments. However, there are several unique variables that may alter FIT performance in this setting, including endemic intestinal parasites and high ambient temperature. This prospective study evaluated the performance of FIT in asymptomatic, average-risk individuals of screening age in rural Nigeria. Methods: Three hundred and twenty-four community volunteers completed a questionnaire and provided stool specimens for parasitology and microbiome analysis. Specimens were frozen and stored at −80 °C. Of 324 subjects, 139 met criteria for average-risk CRC screening and had a stool sample for analysis. These were thawed and tested with a qualitative FIT. Specimens positive for occult blood were retested every two days to evaluate the impact of time and temperature on test performance. Results: Of 139 individuals, 69 (49.6%) were positive for intestinal parasites and 10 (7.2%) were positive for occult blood. The most common pathogen was Cryptosporidium (40.6%). Among patients with intestinal parasites, 10.1% (7/69) had a positive FIT. Only 4.3% (3/70) of patients without parasites had a positive FIT (p = 0.208). On bivariate analysis, sociodemographic variables were not associated with a positive FIT result. Thirty percent (3/10) of the FIT-positive specimens became FIT-negative with routine storage. Conclusion: Although a positive FIT result was more common in those with parasitic infection, the relationship was not significant in this small cohort. The impact of high ambient temperature on test positivity may necessitate shorter processing time guidelines for equatorial countries. Additional prospective studies are needed to validate FIT performance in Nigeria.

Original languageEnglish (US)
JournalWorld Journal of Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Nigeria
Early Detection of Cancer
Colorectal Neoplasms
Parasites
Occult Blood
Temperature
Prospective Studies
Parasitology
Cryptosporidium
Parasitic Diseases
Microbiota
Volunteers
Hemoglobins
Guidelines

ASJC Scopus subject areas

  • Surgery

Cite this

Knapp, G. C., Sharma, A., Olopade, B., Alatise, O. I., Olasehinde, O., Arije, O. O., ... Kingham, T. P. (Accepted/In press). An Exploratory Analysis of Fecal Immunochemical Test Performance for Colorectal Cancer Screening in Nigeria. World Journal of Surgery. https://doi.org/10.1007/s00268-019-05100-0

An Exploratory Analysis of Fecal Immunochemical Test Performance for Colorectal Cancer Screening in Nigeria. / Knapp, Gregory C.; Sharma, Avinash; Olopade, Bolatito; Alatise, Olusegun I.; Olasehinde, Olalekan; Arije, Olujide O.; Castle, Philip E.; Kingham, T. Peter.

In: World Journal of Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Knapp, Gregory C. ; Sharma, Avinash ; Olopade, Bolatito ; Alatise, Olusegun I. ; Olasehinde, Olalekan ; Arije, Olujide O. ; Castle, Philip E. ; Kingham, T. Peter. / An Exploratory Analysis of Fecal Immunochemical Test Performance for Colorectal Cancer Screening in Nigeria. In: World Journal of Surgery. 2019.
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abstract = "Introduction: The fecal immunochemical test (FIT) for hemoglobin is recommended for colorectal cancer (CRC) screening in resource-limited environments. However, there are several unique variables that may alter FIT performance in this setting, including endemic intestinal parasites and high ambient temperature. This prospective study evaluated the performance of FIT in asymptomatic, average-risk individuals of screening age in rural Nigeria. Methods: Three hundred and twenty-four community volunteers completed a questionnaire and provided stool specimens for parasitology and microbiome analysis. Specimens were frozen and stored at −80 °C. Of 324 subjects, 139 met criteria for average-risk CRC screening and had a stool sample for analysis. These were thawed and tested with a qualitative FIT. Specimens positive for occult blood were retested every two days to evaluate the impact of time and temperature on test performance. Results: Of 139 individuals, 69 (49.6{\%}) were positive for intestinal parasites and 10 (7.2{\%}) were positive for occult blood. The most common pathogen was Cryptosporidium (40.6{\%}). Among patients with intestinal parasites, 10.1{\%} (7/69) had a positive FIT. Only 4.3{\%} (3/70) of patients without parasites had a positive FIT (p = 0.208). On bivariate analysis, sociodemographic variables were not associated with a positive FIT result. Thirty percent (3/10) of the FIT-positive specimens became FIT-negative with routine storage. Conclusion: Although a positive FIT result was more common in those with parasitic infection, the relationship was not significant in this small cohort. The impact of high ambient temperature on test positivity may necessitate shorter processing time guidelines for equatorial countries. Additional prospective studies are needed to validate FIT performance in Nigeria.",
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AB - Introduction: The fecal immunochemical test (FIT) for hemoglobin is recommended for colorectal cancer (CRC) screening in resource-limited environments. However, there are several unique variables that may alter FIT performance in this setting, including endemic intestinal parasites and high ambient temperature. This prospective study evaluated the performance of FIT in asymptomatic, average-risk individuals of screening age in rural Nigeria. Methods: Three hundred and twenty-four community volunteers completed a questionnaire and provided stool specimens for parasitology and microbiome analysis. Specimens were frozen and stored at −80 °C. Of 324 subjects, 139 met criteria for average-risk CRC screening and had a stool sample for analysis. These were thawed and tested with a qualitative FIT. Specimens positive for occult blood were retested every two days to evaluate the impact of time and temperature on test performance. Results: Of 139 individuals, 69 (49.6%) were positive for intestinal parasites and 10 (7.2%) were positive for occult blood. The most common pathogen was Cryptosporidium (40.6%). Among patients with intestinal parasites, 10.1% (7/69) had a positive FIT. Only 4.3% (3/70) of patients without parasites had a positive FIT (p = 0.208). On bivariate analysis, sociodemographic variables were not associated with a positive FIT result. Thirty percent (3/10) of the FIT-positive specimens became FIT-negative with routine storage. Conclusion: Although a positive FIT result was more common in those with parasitic infection, the relationship was not significant in this small cohort. The impact of high ambient temperature on test positivity may necessitate shorter processing time guidelines for equatorial countries. Additional prospective studies are needed to validate FIT performance in Nigeria.

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