Multiple FIT tests offer best diagnostic yield for advanced neoplasia

  • Clin Gastroenterol Hepatol

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Multiple rounds of mailed fecal immunohistochemical tests (FITs) had a better diagnostic yield for detecting advanced neoplasias than 1-time colonoscopy or 1-time flexible sigmoidoscopy for general colorectal cancer (CRC) screening.

Why this matters

  • The study is the first to examine multiple FITs vs endoscopic methods for CRC screening.

Study design

  • Combined analysis of 3 population trials (n=30,052; the Netherlands).
  • FIT participants received 4 kits, mailed every 2 years for 4 rounds.
  • Others received an invitation to schedule a colonoscopy or flexible sigmoidoscopy.
  • Funding: The Netherlands Organization for Health Research and Development.

Key results

  • FIT screening was associated with a higher participation rate (73%) than flexible sigmoidoscopy (31%; P<.001 or colonoscopy p>
  • An intention-to-treat analysis showed higher cumulative diagnostic yield of advanced neoplasia for FIT screening (4.5%; 95% CI, 4.2%-4.9%) vs colonoscopy (2.2%; 95% CI, 1.8%-2.6%) or flexible sigmoidoscopy (2.3%; 95% CI, 2.0%-2.7%).
  • An as-screened analysis showed the highest diagnostic yield of advanced neoplasia for colonoscopy (9.1%; 95% CI, 7.7%-10.7%), followed by flexible sigmoidoscopy (7.4%; 95% CI, 6.5%-8.5%) and FIT (6.1%; 95% CI, 5.7%-6.6%).
  • CRC diagnoses were similar between the groups.
  • Interval CRC frequency:
    • Negative FIT, 0.13%.
    • Negative flexible sigmoidoscopy, 0.09%.
    • Negative colonoscopy, 0.01%.

Limitations

  • Secondary analysis.