Annual FIT Screening Feasible for CRC Screening

Annual fecal immunochemical test (FIT) screening was associated with high sensitivity for colorectal cancer (CRC), with high adherence to annual follow-up screening among initial participants, a study published in the journal Annals of Internal Medicine has shown.¹

FIT is a common approach for CRC screening, but its acceptability and performance over numerous rounds of annual testing remained mostly unclear. Therefore, researchers sought to evaluate FIT performance characteristics over 4 rounds of annual screening in a retrospective study.

For the study, investigators analyzed data from 323 349 health plan members aged 50 to 70 years who completed the first round of FIT and were followed for up to 4 screening rounds.

Results showed that of the patients invited for screening, 48.2% participated in round 1, and of those who remained eligible, 75.3% to 86.1% participated in subsequent rounds over a median follow-up of 4 years.

Researchers found that 32% of round 1 participants underwent endoscopy at some point over the 4 screening rounds. Of those, 7.0% were because of a positive FIT result.

The study further demonstrated a FIT positivity rate of 5.0% and a positive predictive value of 51.5% for adenomas and 3.4% for CRC during round 1, which was the highest of all rounds.

Programmatic FIT screening ultimately detected 80.4% of patients with CRC diagnosed within 1 year of testing, including 84.5% in round 1 and 73.4% to 78.0% in subsequent rounds.

Although the study is limited by the fact that screening detection, rather than long-term cancer prevention, was assessed, the findings suggested that annual programmatic FIT screening is effective and feasible for CRC screening on the population level.

Reference

1. Jensen CD, Corley DA, Quinn VP, et al. Fecal immunochemical test program performance over 4 rounds of annual screening: a retrospective cohort study [published online ahead of print January 26, 2016]. Ann Intern Med. doi: 10.7326/M15-0983.