To test this hypothesis, both

short-term and long-term indicators of performance are needed; the former includes SB431542 mouse the positive predictive value, cancer detection rate, interval cancer rate, and test sensitivity, and the latter is based mainly on the CRC-specific mortality rate.7 Without a large population-based longitudinal follow-up cohort, a thorough evaluation employing all of these indicators is difficult. However, a nationwide cohort composed of nearly 1 million CRC-screened subjects recently became available in Taiwan. This cohort was therefore utilized in the present study to ascertain whether 2 different brands of FIT, which claim to have identical cutoff hemoglobin concentrations in feces,

perform equivalently for mass screening. Both short-term and long-term indicators of performance were measured to test this hypothesis. Beginning in 2004, the Taiwanese Nationwide CRC Perifosine concentration Screening Program invited residents aged 50 to 69 years to receive a biennial FIT.5 The main purpose of mass screening was to reduce mortality from CRC. To cover approximately 5.5 million eligible residents in a total of 25 municipalities, the Health Promotion Administration, Ministry of Health and Welfare (formerly Bureau of Health Promotion) set the coverage rate every 2 years for each municipality according to the screening budget and manpower capacity. Mass screening, including the processes of invitation, distribution of FIT, and testing of fecal sample, the referral for colonoscopic examination, and the histopathologic diagnosis were performed in a stepwise manner at local public health units, clinics, and hospitals in each municipality, with approximately

810 screening sites participating in the program. All screening results were transmitted via a virtual private network to a central database to periodically generate standardized indicators such that central and local governments could monitor the screening performance. The 1-day method was adopted, and participants were advised to return the specimens for testing immediately after they were taken. Quantitative FIT Urocanase testing was performed at approximately 125 qualified laboratories. In addition to recording a positive or negative result, numerical data were stored in the database for possible adjustment of the cutoff hemoglobin concentration. Test results were reported to all participants by mail and/or telephone. The choice of FIT was based on the open bidding process at local Public Health Bureaus and hospitals. Two major brands of FIT accounted for approximately 82.4% of all FITs in use; these were the OC-Sensor and the HM-Jack tests with the respective cutoff concentrations of 100 and 8 ng hemoglobin/mL buffer.