Noninvasive fecal immunochemical testing is an effective alternative to colonoscopy and stool blood-based screening methods for colorectal cancer screening, according to an opinion article published in the Annals of Internal Medicine.
“Colonoscopy accounts for at least 60% of all [colorectal cancer prevention (CRC)] screening in the United States, despite its greater expense and risk for complications compared with other options,” David S. Weinberg, MD, MSc, from the department of medicine at Fox Chase Cancer Center, and colleagues wrote. “Review of this evidence has prompted national CRC screening programs in Europe, Asia, and elsewhere to emphasize guaiac-based fecal occult blood testing (gFOBT) and, more recently, fecal immunochemical testing (FIT) as the primary screening methods.”
Due to the controversial features of colorectal cancer (CRC) screening, the US Multi-Society Task Force, which includes major U.S. gastroenterological professional associations, compared the advantages of FIT over other screening methods, including gFOBT. Commonly seen as purely a detection method, recent modeling studies show FIT-based screening yields reductions in CRC incidence similar to those of colonoscopy when patients adhere to ongoing completion.
Using pooled analyses, research showed the 79% sensitivity (95% CI, 69-86) of FIT surpassed the estimated 35% sensitivity of gFOBT, while maintaining a similar specificity of 94% (95% CI, 92-95). FIT detected advanced adenomas more consistently than gFOBT, as shown in a meta-analysis of randomized, controlled trials where FIT uncovered twice as many CRCs and advanced adenomas (RR = 2.28; 95% CI, 1.68-3.1). Researchers also found patients prefer FIT to gFOBT, a distinct advantage because a major challenge in CRC screening is sustained adherence, according to the authors.
“At present, colonoscopy and stool testing for blood are the only readily available CRC screening tests in the United States,” Weinberg and colleagues wrote. “For improvements in CRC prevention and early detection to continue, patients must have access to several effective, low- or no-cost screening options... FIT is a worthy component of any average risk screening process.” — by Savannah Demko
Disclosure: The researchers report no relevant financial disclosures.