Fecal immunochemical testing (FIT)-based screening is associated with a reduction in overall and advanced-stage colorectal cancer (CRC) incidence and is likely to detect CRC at an early stage, according to a study in the Lancet Gastroenterology & Hepatology.

The retrospective, observational study assessed CRC incidence and mortality rates before and after introduction of the Dutch national CRC screening program, which was launched in 2014. The program utilized FIT to detect and quantify human hemoglobin level in feces once every 2 years.

Investigators collected CRC incidence data from the Netherlands Cancer Registry (NCR) from January 1, 2010, to December 31, 2019, in individuals aged 55 years or older. Patients diagnosed with CRC from January 1, 2014, to December 31, 2018, in the NCR were linked with the Dutch nationwide registry of histopathology and cytopathology (PALGA) to identify whether the mode of detection was screening-based or clinical.

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The researchers calculated age-standardized CRC incidence rates and used data from Statistics Netherlands to calculate CRC-related mortality from 2010 to 2019. They compared tumor localization, stage distribution, and treatment of screening-detected CRC cases with clinically detected CRC cases diagnosed from 2014 to 2018.

A total of 125,215 CRC cases were diagnosed in individuals aged 55 years or older between January 1, 2010, and December 31, 2019, and were included in the analyses.

CRC incidence in individuals aged 55 years or older decreased slightly from 2010 to 2013 (annual percentage change, -1.2% [95% CI, -4.1 to 1.8]). Afterward, CRC incidence increased temporarily from 214.3 per 100,000 population in 2013 to 259.2 per 100,000 population in 2015 after initiation of the screening program (annual percentage change, 10.1% for 2013 to 2015). CRC incidence decreased to 181.5 per 100,000 population in 2019.

The incidence of advanced-stage CRC was 117.0 per 100,000 population in 2013, and it increased slightly until 2015, when it reached 122.8 per 100,000 population (annual percentage change, 0.9% [95% CI, -0.7 to 2.5] for 2010 to 2015). After 2015, a significant decrease occurred, with an incidence of 94.7 per 100,000 population in 2018 (annual percentage change, -8.3% [95% CI, -11.5 to -4.9] for 2015 to 2018).

Screening-detected CRC cases were more likely to be left-sided (6593 [48.6%] of 13,565 cases vs 11,005 [35.2%] of 31,311 cases; P <.0001), more likely to be stage I (6406 [47.2%] of 13,565 cases vs 7182 [22.9%] of 31311 cases; P <.0001), and less likely to be stage III or IV (4291 cases [31.6%] vs 16,483 cases [52.6%]; P <.0001), compared with CRC cases that were clinically detected.

Patients with screening-detected CRC were also more likely to be treated with local excision vs those with clinically detected CRC, for both colon and rectal cancers (P <.0001 for both).

The investigators noted that the main limitation of their study was its ecological design, which could introduce confounders that may affect the observed associations between screening and CRC incidence and related mortality.

“[O]ur data show that after introduction of the Dutch CRC screening program, overall and advanced-stage CRC incidence decreased, which indicates that FIT-based CRC screening is effective,” the researchers stated. “The decrease in advanced-stage CRC incidence coupled with the improved treatment options of screening-detected CRCs might decrease CRC-related mortality in the long-term.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Breekveldt ECH, Lansdorp-Vogelaar I, Toes-Zoutendijk E, et al. Colorectal cancer incidence, mortality, tumour characteristics, and treatment before and after introduction of the faecal immunochemical testing-based screening programme in the Netherlands: a population-based study. Lancet Gastroenterol Hepatol. 2022;7(1):60-68. doi: 10.1016/S2468-1253(21)00368-X