{"doi":"10.1093/jnci/djaf149","title":"Benefits of colorectal cancer screening using fecal immunochemical testing with varying positivity thresholds by age and sex","abstract":"BACKGROUND: Fecal immunochemical test (FIT) performance for colorectal cancer screening varies by age and sex, yet most FIT-based screening programs use uniform positivity thresholds. This study assessed the potential benefits of stratifying FIT thresholds based on age and sex. METHODS: We conducted a meta-analysis of FIT sensitivity and specificity at various positivity thresholds by age and sex. We then used these estimates in 2 microsimulation models of colorectal cancer and projected lifetime clinical outcomes, incremental costs, and quality-adjusted life-years (QALYs) gained from age- and sex-stratified FIT strategies. FIT thresholds ranged from 10 to 50 µg hemoglobin per gram of feces. RESULTS: For current uniform FIT screening (20 µg hemoglobin/gram of feces), models projected 85.67 to 122.15 QALYs gained at incremental costs of ‒$982 to $504 per 1000 individuals compared with no screening. At equivalent costs to current uniform screening, only 1 model found stratified FIT approaches cost-effective, yielding a marginal increase of 1.04 and 1.10 QALYs gained/1000 female and male individuals, respectively. At a willingness-to-pay threshold of $100 000/QALYs gained, both models found stratified FIT cutoffs to be the best strategy, with cutoffs being equal to or higher for males and lowest at older ages (70-75 years). Uniform strategies showed comparable effectiveness, falling within 1 quality-adjusted life-day per person of efficient strategies at up to $112 more per person. Results were sensitive to FIT test performance characteristics and 1-time setup costs. CONCLUSION: Stratifying FIT thresholds by age and sex may be cost-effective compared to current screening. The gain in expected health benefits with stratified FIT screening, however, is likely small.","journal":"JNCI Journal of the National Cancer Institute","year":2025,"id":539682,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9585,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":995668,"name":"Amy B. Knudsen","orcid":"0000-0003-1872-996X","position":1,"is_corresponding":false},{"id":1028257,"name":"Daan Nieboer","orcid":"0000-0002-4403-6537","position":2,"is_corresponding":false},{"id":1180950,"name":"Luuk A van Duuren","orcid":"0000-0002-6286-8062","position":3,"is_corresponding":false},{"id":418588,"name":"Karen M. Kuntz","orcid":"0000-0001-6335-7590","position":4,"is_corresponding":false},{"id":776114,"name":"Carolyn M. Rutter","orcid":"0000-0002-4396-8594","position":5,"is_corresponding":false},{"id":776115,"name":"Pedro Nascimento de Lima","orcid":"0000-0001-9057-198X","position":6,"is_corresponding":false},{"id":432510,"name":"Nicholson Collier","orcid":"0000-0002-2376-4156","position":7,"is_corresponding":false},{"id":381323,"name":"Jonathan Ozik","orcid":"0000-0002-3495-6735","position":8,"is_corresponding":false},{"id":986383,"name":"Anne I. Hahn","orcid":"0000-0003-4061-2303","position":9,"is_corresponding":false},{"id":271680,"name":"Fernando Alarid‐Escudero","orcid":"0000-0001-5076-1172","position":10,"is_corresponding":false},{"id":6449,"name":"Ann G. Zauber","orcid":"0000-0002-1764-5994","position":11,"is_corresponding":false},{"id":310992,"name":"John M. Inadomi","orcid":"0000-0001-6776-8661","position":12,"is_corresponding":false},{"id":282319,"name":"Reinier G.S. Meester","orcid":"0000-0003-4645-1221","position":13,"is_corresponding":false},{"id":1427613,"name":"Iris Lansdorp Vogelaar","orcid":null,"position":14,"is_corresponding":false},{"id":986925,"name":"Matthias Harlass","orcid":null,"position":0,"is_corresponding":true}],"reference_count":33,"raw_metadata":null,"created_at":"2026-07-19T02:52:34.520788Z","pmid":"40581741","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}