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J Med Screen. 2016 Dec;23(4):186-191. Epub 2016 Apr 28.

Ambient temperature and FIT performance in the Emilia-Romagna colorectal cancer screening programme.

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Azienda Usl di Modena, Department of Public Health, Unit of Epidemiology and Risk communication, Modena, Italy
Azienda Usl di Modena, Department of Public Health, Unit of Epidemiology and Risk communication, Modena, Italy.
Azienda Usl di Modena, Colorectal screening programme Modena, Italy.
Cancer Registry Romagna, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
Department of Health, Emilia-Romagna Region, Bologna, Italy.
Regional Center for Environment and Health, ARPA Emilia-Romagna, Modena, Italy.



To assess the impact of ambient temperature on faecal immunochemical test (FIT) performance in the colorectal cancer screening programme of Emilia-Romagna (Italy).


A population-based retrospective cohort study on data from 2005 to 2011. Positive rate, detection rate, and positive predictive value rate for cancers and adenomas, and incidence rate of interval cancers after negative tests were analysed using Poisson regression models. In addition to ambient temperature, gender, age, screening history, and Local Health Unit were also considered.


In 1,521,819 tests analysed, the probability of a positive result decreased linearly with increasing temperature. Point estimates and 95% Confidence Intervals were estimated for six temperature classes (<5, 5 |-10, 10 |-15, 15 |-20, 20|-25 and ≥25℃), and referred to the 5|-10℃ class. The positive rate ratio was significantly related to temperature increase: 0.99 (0.97-1.02), 1, 0.98 (0.96-1.00), 0.96 (0.94-0.99), 0.93 (0.91-0.96), 0.92 (0.89-0.95). A linear trend was also evident for advanced adenoma detection rate ratio: 1.00 (0.96-1.04), 1, 0.98 (0.93-1.02), 0.96 (0.92-1.00), 0.92 (0.88-0.96), 0.94 (0.88-1.01). The effect was less linear, but still important, for cancer detection rates: 0.95 (0.85-1.06), 1, 1.00 (0.90-1.10), 0.94 (0.85-1.05), 0.81 (0.72-0.92), 0.93 (0.80-1.09). No association or linear trend was found for positive predictive values or risk of interval cancer, despite an excess of +16% in the highest temperature class for interval cancer.


Ambient temperatures can affect screening performance. Continued monitoring is needed to verify the effect of introducing FIT tubes with a new buffer, which should guarantee a higher stability of haemoglobin.


Colorectal cancer screening; faecal immunochemical test; interval cancer; occult blood; temperature

[Indexed for MEDLINE]

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