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Disclosures: Issaka reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
April 14, 2021
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Fecal immunochemical testing increases CRC screening, diagnoses

Disclosures: Issaka reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Increased use of fecal immunochemical testing correlated with more colorectal cancer screenings and early-stage diagnoses amid the COVID-19 pandemic, according to research in JAMA Network Open.

“When CMS recommended delaying all non-urgent procedures, including screening colonoscopies, CRC screening declined by 90%,” Rachel B. Issaka, MD, MAS, Hutchinson Cancer Research Center in Seattle, Wash., told Healio. “We described how stool-based tests, including the fecal immunochemical test (FIT), had the potential to improve CRC screening and detection during the pandemic, but we were curious about the exact impact this intervention could have.”

“Proactive strategies such as increased use of fecal immunochemical test-based colorectal cancer screening, particularly through organized mailed outreach, may help limit the undoing of public health progress in colorectal cancer.” Rachel B. Issaka, MD, MAS

To investigate how the expansion of fecal immunochemical testing (FIT) participation affected CRC outcomes, researchers analyzed adults screened for CRC using a previously developed simulation model of pre-COVID U.S. screening data from the American Cancer Society. The model calculated estimates of CRC outcomes between 2020 and 2023 for 9-months of 50% CRC screenings followed by 21-months of 75% CRC screenings and 18-months of 50% screening followed by 12-months of 75% screening; the model also calculated estimates with adjustment for the increased use of FITs.

According to study estimations, COVID-19 reductions in care yielded 1,176,942 to 1,014,164 fewer CRC screenings, 8,346 to 12,894 fewer CRC diagnoses and 6,113 to 9,301 fewer early-stage CRC diagnoses. Adjustment for increased FIT use correlated with an estimated additional 588,844 CRC screenings and an estimated additional 2,836 CRC diagnoses (68.9% early-stage CRC). Researchers noted, in the event of prolonged reduction of CRC screenings, increased use of FITs correlated with an additional 655,825 screenings and 2,715 CRC diagnoses (71.6% early-stage CRC).

“Mailed FIT outreach is an evidence-based intervention that improves CRC screening participation and reduces racial/ethnic disparities in outcomes by improving access to care. As the pandemic continues, it’s time to implement this strategy more broadly in the U.S. to decrease missed and delayed CRC diagnoses and deaths,” Issaka concluded. “If our estimates are born out in real-world clinical practice, proactive strategies, such as increased use of FIT-based CRC screening, may help limit the undoing of public health progress in CRC.”