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Effect of aspirin, warfarin, and proton-pump inhibitors on performance of fecal immunochemical test in colorectal cancer screening: a systematic review and meta-analysis

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Abstract

This study aims to investigate the impact of antithrombotic agents and proton-pump inhibitors (PPIs) on fecal immunochemical test (FIT). PubMed, EMBASE, Web of Science, Cochrane Central, and Google Scholar were searched from inception until September 3, 2023. Studies comparing the diagnostic performance of FIT between medicine users and non-users in average-risk colorectal cancer screening populations were included. Pooled sensitivity, specificity, and positive predictive values (PPVs) for advanced neoplasia (AN) of FIT were compared by reporting pooled odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model. Twenty-two studies enrolling 5,572,367 individuals were included. For aspirin, pooled sensitivity and specificity for AN were 57.2% and 88.4% in users versus 60.2% and 93.2% in non-users; while pooled ORs were 1.49 (95% CI 0.89–2.48, P = 0.13) and 0.72 (95% CI 0.62–0.83, P < 0.001), respectively. In subgroup analysis, there was no difference in sensitivity and specificity between the two groups at the cutoff of 20 μg Hb/g (P = 0.57 and 0.29, respectively) but a significantly lower specificity in users compared with non-users at lower cutoffs (P < 0.001). Moreover, a significantly lower PPVAN in users compared with non-users was observed after matching age and sex confounders (P = 0.001). Warfarin had no significant influence on PPVAN of FIT (P = 0.43). PPIs were associated with a significantly lower PPVAN in users (P < 0.001). Aspirin use was associated with lower specificity and PPV of FIT. Aspirin discontinuation before FIT to reduce false-positive results should be interpreted with caution given concerns about cardiovascular events. Increasing cutoff values of FIT in aspirin users may be another possible approach. Additionally, warfarin withdrawal before FIT is unnecessary but PPIs withdrawal before FIT is recommended to reduce false-positive results.

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Acknowledgements

We thank all authors who provided data for this meta-analysis. We would like to thank Editage (www.editage.cn) for English language editing.

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  1. Zhongxue Han and Xueping Nan have contributed equally to this article.

Authors and Affiliations

  1. Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China

    Zhongxue Han, Xueping Nan, Mingjun Ma, Ruchen Zhou, Peizhu Wang, Jing Liu, Yanqing Li & Yueyue Li

  2. Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

    Zhongxue Han, Xueping Nan, Mingjun Ma, Ruchen Zhou, Peizhu Wang, Jing Liu, Yanqing Li & Yueyue Li

  3. Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

    Zhongxue Han, Xueping Nan, Mingjun Ma, Ruchen Zhou, Peizhu Wang, Jing Liu, Yanqing Li & Yueyue Li

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Contributions

ZXH and XPN were responsible for design of this research and drafted the manuscript. YYL and MJM collected and analyzed the data. RCZ, JL and PZW provided critical revision of the manuscript. YQL supervised the implementation of the whole process. All authors read and approved the final manuscript. We thank all collaborators who contributed to this study.

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Correspondence to Yueyue Li.

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Han, Z., Nan, X., Ma, M. et al. Effect of aspirin, warfarin, and proton-pump inhibitors on performance of fecal immunochemical test in colorectal cancer screening: a systematic review and meta-analysis. Clin Exp Med 23, 4355–4368 (2023). https://doi.org/10.1007/s10238-023-01196-w

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