Background: The potential role of the fecal immunochemical test (FIT) in individuals with a family history of colorectal cancer (CRC) remains unclear. We assessed interval cancer rate (ICR) after the FIT and FIT diagnostic performance according to family history of CRC. Methods: Using the Korean National Cancer Screening Program Database, we collected data on subjects who underwent the FIT between 2009 and 2011. The interval cancer rate (ICR) was defined as the number of subjects diagnosed with CRC within 1 year after the FIT per 1000 subjects with negative FIT results. Results: Of 5,643,438 subjects, 224,178 (3.97%) had a family history of CRC. FIT positivity rate (6.4% vs. 5.9%; adjusted relative risk (aRR) 1.11; 95% confidence interval (CI) 1.09–1.13) and ICR (1.4 vs. 1.1; aRR 1.43 (95% CI 1.27–1.60)) were higher in these subjects than in those with no such history. These results were the same regardless of whether subjects had undergone colonoscopy within the last 5 years before the FIT. However, the diagnostic performance of the FIT for CRC, as measured using the area under the operating characteristic curve, was similar between subjects without a family history and those with one (85.5% and 84.6%, respectively; p = 0.259). Conclusion: the FIT was 1.4 times more likely to miss CRC in subjects with a family history than in those without (aRR 1.43 for ICR), although its diagnostic performance was similar between the two groups. Our results suggest that for individuals with a family history of CRC, colonoscopy should be preferred over FIT for both screening and surveillance.

中文翻译：

---

根据大肠癌家族史的间隔癌率和粪便免疫化学测试的诊断性能

背景：粪便免疫化学测试（FIT）在具有大肠癌家族史（CRC）的个体中的潜在作用仍不清楚。我们根据CRC家族史评估了FIT和FIT诊断表现后的间歇性癌症发生率（ICR）。方法：使用韩国国家癌症筛查计划数据库，我们收集了2009年至2011年接受FIT的受试者的数据。间歇性癌症发生率（ICR）定义为FIT后1年内被诊断为CRC的受试者每千名FIT结果阴性的受试者。结果：在5,643,438名受试者中，有224,178名（3.97％）具有CRC家族史。FIT阳性率（6.4％vs. 5.9％；调整后相对风险（aRR）1.11； 95％置信区间（CI）1.09-1.13）和ICR（1.4 vs. 1.1； aRR 1.43（95％CI 1.27-1）。60））在这些受试者中比没有这些病史的受试者更高。无论受试者在FIT之前的最近5年内是否接受过结肠镜检查，这些结果都是相同的。但是，使用操作特征曲线下的面积测量的FIT对CRC的诊断性能在没有家族史的受试者和有家族史的受试者之间分别相似（分别为85.5％和84.6％；p = 0.259）。结论：具有家族史的受试者中，FIT错过CRC的可能性比没有家族史的受试者高1.4倍（ICR的aRR为1.43），尽管两组的诊断性能相似。我们的结果表明，对于有CRC家族史的人，在筛查和监视方面均应首选结肠镜检查而不是FIT。