Fecal immunochemical test (FIT) screening for colorectal cancer (CRC) prevents progression of a subset of advanced adenomas, and screening intensity could be modulated with a risk-based strategy using data resulting from previous rounds, according to results of a study published in Clinical Gastroenterology and Hepatology.

Little is known about the magnitude and temporal patterns of the decreasing trends in main performance measures of FIT screening for CRC that have been observed in second and subsequent rounds. Researchers evaluated the performance of compliant participation in the first 5 rounds of a biennial FIT screening program in Italy from 2005 to 2016. Investigators followed 494,187 participants, and performance measures from the first, third, fourth, and fifth rounds of FIT were compared with those from the second round.

Results demonstrated that compliant participants had a lower proportion of positive FIT results than the total screening population. For these participants, some major performance measures continued to decrease even after the expected drop between the first and the second round. Between the second and the third round, the proportion of positive FIT results and the detection rate of advanced adenoma, CRC, and advanced neoplasia decreased by 20% to 30% among men. For both genders, the detection rate of distal colon cancer decreased until the fourth and fifth rounds in men and women, respectively.

Study limitations include a “sharp decrease” in the number of participants undergoing FIT between the first and fifth rounds, an inability to generalize results to different screening protocols, and the potential for bias.


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“These findings add circumstantial evidence that FIT screening prevents the progression of an appreciable subset of advanced adenomas, and have implications for the communication of benefits and harms of the screening process, the planning of endoscopy services, and the development of risk-based screening strategies,” the authors concluded.

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Reference

Baldacchini F, Bucchi L, Giuliani O, et al; on behalf of the Emilia-Romagna Region Workgroup for Colorectal Screening Evaluation Stefano Ferretti. Results of compliant participation in 5 rounds of fecal immunochemical test screening for colorectal cancer [published online August 19, 2020]. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2020.08.038