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Open Access Research article

A prospective analysis of false positive events in a National Colon Cancer Surveillance Program

Knut Magne Augestad123*, Jan Norum45, Johnie Rose67 and Rolv-Ole Lindsetmo35

Author Affiliations

1 Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA

2 Norwegian Center of Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway

3 Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway

4 Northern Norway Regional Health Authority Trust, Bodø, Norway

5 Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø – The Artic University of Norway, Tromsø, Norway

6 Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA

7 Case Comprehensive Cancer Center, Cleveland, OH, USA

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BMC Health Services Research 2014, 14:137  doi:10.1186/1472-6963-14-137

Published: 27 March 2014

Abstract

Background

The survival benefits of colon cancer surveillance programs are well delineated, but less is known about the magnitude of false positive testing. The objective of this study was to estimate the false positive rate and positive predictive value of testing as part of a surveillance program based on national guidelines, and to estimate the degree of testing and resource use needed to identify a curable recurrence.

Methods

Analysis of clinically significant events leading to suspicion of cancer recurrence, false positive events, true cancer recurrences, time to confirmation of diagnosis, and resource use (radiology, blood samples, colonoscopies, consultations) among patients included in a randomised colon cancer surveillance trial.

Results

110 patients surgically treated for colon cancer were followed according to national guidelines for 1884 surveillance months. 1105 tests (503 blood samples, 278 chest x-rays, 209 liver ultrasounds, 115 colonoscopies) and 1186 health care consultations were performed. Of the 48 events leading to suspicion of cancer recurrence, 34 (71%) represented false positives. Thirty-one (65%) were initiated by new symptoms, and 17 (35%) were initiated by test results. Fourteen patients had true cancer recurrence; 7 resections of recurrent disease were performed, 4 of which were successful R0 metastasis Resections. 276 tests and 296 healthcare consultations were needed per R0 resection; the cost per R0 surgery was £ 103207. There was a 29% probability (positive predictive value) of recurrent cancer when a diagnostic work-up was initiated based on surveillance testing or patient complaints.

Conclusion

We observed a high false positive rate and low positive predictive value for significant clinical events suggestive of possible colorectal cancer relapse in the setting of a post-treatment surveillance program based on national guidelines. Providers and their patients should have an appreciation for the modest positive predictive value inherent in colorectal cancer surveillance programs in order to make informed choices, which maximize quality of life during survivorship. Better means of tailoring surveillance programs based on patient risk would likely lead to more effective and cost-effective post-treatment follow-up.

Trial registration

ClinicalTrials.gov identifier NCT00572143. Date of trial registration: 11th of December 2007.

Keywords:
Colorectal cancer; Surveillance; Follow-up; False positive test; Positive predictive value; Metastases resection; Cost-effectiveness