5 mg and 1.25 mL, respectively, for HM-Jack, the cutoff hemoglobin concentrations in buffer for both tests were equivalent to 20 μg hemoglobin/g

feces. To monitor quality control within individual laboratories, the Health Promotion Administration has authorized the Taiwan Society of Laboratory Medicine to provide these laboratories with hemoglobin solutions and hemoglobin-spiked, stool-like matrix samples to test occult blood using both FITs every 6 months. Participating laboratories were required to analyze these test materials and return the findings for evaluation. Only accredited laboratories with findings that met the requirements of the International Organization for Standardization 15189 could participate in the nationwide program. A participant with a positive test was referred to one of approximately 485 hospitals Akt inhibitor for the confirmatory diagnosis with either a total colonoscopy or sigmoidoscopy plus barium enema. Details regarding size, location, and histopathology for

colonic neoplasms were recorded. The histopathology of a colorectal neoplasm was classified according to the criteria of the World Health Organization.8 Test performance was evaluated based on data from the prevalence screening. Short-term indicators included positive predictive value for cancer detection (number with cancer/total number of diagnostic endoscopies) and cancer detection SPTLC1 rate (number with cancer/tested selleck products population). The detection of advanced adenoma, which was defined as an adenoma of ≥10 mm in diameter or having a villous component or high-grade dysplasia, was included in the calculations for the above indicators. The per-person analysis was used for both the CRC (ie, an individual discovered with metachronous cancers counted as one individual with cancer) and advanced adenoma (ie, the

most advanced finding being an advanced adenoma). Short-term indicators also included the interval cancer rate (number of invasive cancers diagnosed after a negative FIT and <2 years to the next screen/total person-years at risk). To ascertain the occurrence of incident CRC, the screening database was linked with the Taiwan Cancer Registry, a nationwide program with high coverage (99%; each hospital mandated to report all cases of CRC) and high accuracy (percentage of death-certificate–only cases of <1% for CRC).9 The indicator of test sensitivity was generated from the number of interval cancers using the proportional incidence method based on age- and sex-specific incidence rates derived from the Taiwan Cancer Registry. Adjustments were also made for the variation of sojourn time during which CRC remained in the preclinical detectable phase.