What percent should be a reasonable positivity rate of immunological fecal occult blood testing?

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  • 大腸がん検診の適正な要精検率をめざして
  • ダイチョウ ガン ケンシン ノ テキセイナ ヨウセイケンリツ オ メザシテ

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To speculate the optimal cut off value for the immunological fecal occult blood testing (IFOBT), we analyzed 332 cases of colorectal cancer (early: 235; advance: 66; unknown: 31) detected among the 151,839 subjects who received an IFOBT (cut off value: 40 ng/ml) during April 2001 through March 2006. Using the receiver operating characteristic curve, the optimal cut off value was evaluated at 110 ng/ml, for which positivity rate and false negative rate were 3.1% and 36.7% (early: 101 cases; advance: 10; unknown: 11), respectively. With a threshold of 60 ng/ml corresponding to a positivity rate of 5.2%, the false negative rate decreased to 16.6% (early: 45; advance: 6; unknown: 4) and none of advance cancer subjects under 60 years old became false negative. Under 50 years old, 24 of 27 colorectal cancers (88.9%) were found at early stage. These findings suggested that the positivity rate of 5% (cut off value: 60 ng/ml) seemed reasonable for the IFOBT, if the colorectal cancer screening was more aggressively recommended for subjects 40 years or older.

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