Fecal immunochemical test (FIT)-based screening programs impact both proximal and distal colorectal cancer (CRC) rates, but underlying preexisting epidemiological trends lead to a rapidly increasing percentage of proximal CRC, according to a study published online ahead of print in the journal Cancer.

FIT-based CRC screening programs reduce overall CRC surgery rates, however, data by subset were lacking. The researchers in this study assessed the impact of FIT –based screening on proximal and distal CRC surgical resection rates.

There were three study populations in the trial, all in the Veneto region in Italy. Staggered introduction of FIT-based screening programs were used: early (2002 to 2004), intermediate (2005 to 2007), and late (2008 to 2009). Joinpoint regression analysis and segmented Poisson regression models were used to investigate time series of proximal and distal CRC surgery in the three populations between 2001 and 2012.

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Researchers found similar screening impact across the three populations. Rates of distal CRC surgical resection were stable before screening, increased at the time of screening implementation (rate ratio [RR], 1.25; 95% CI, 1.14, 1.37), and declined by 10% annually (RR, 0.90; 95% CI, 0.88, 0.92).

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Rates of proximal CRC surgical resection increased 4% annually before screening (RR, 1.04; 95% CI, 1.03, 1.05) up until a peak was reached.

After that peak at the time of screening initiation, the trend was reversed and the percentage of proximal CRC surgery rose from 28% in 2001 to 41% in 2012.


  1. Fedeli U, Zorzi M, Urso EDL, et al. Impact of fecal immunochemical test-based screening programs on proximal and distal colorectal cancer surgery rates: A natural multiple-baseline experiment. Cancer. 2015. [epub ahead of print]. doi: 10.1002/cncr.29623.