1. From this retrospective cohort study, annual FIT screening detected the majority of patients diagnosed with colorectal cancer within 1 year of testing.
2. High adherence to annual FIT screening was observed in participants who completed their initial round of testing.
Evidence Rating Level: 2 (Good)
Study Rundown: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Therefore, the development of effective, non-invasive screening tests, has become increasingly important. Fecal immunochemical test (FIT) is a type of fecal blood test that can be performed without dietary or medication restrictions and can be delivered by mail. In this retrospective study, the authors assessed the performance of the FIT program over 4 rounds of annual screening. FIT sensitivity for CRC, FIT positivity (i.e., percentage of patients with positive results), and positive predictive values (PPVs) for adenoma and advanced adenoma were all highest in the first-round of testing and remained lower, but stable, in subsequent rounds. Furthermore, although less than half of patients completed the first-round of testing, over 75% of patients who completed it continued to adhere to the program for the subsequent 3 screenings. This study is limited in that it did not compare FIT outreach to usual care or other screening methods. It also did not assess whether patient outcomes were improved following identification of cancer through FIT screening. Overall, the study suggests that FIT may be a feasible and effective method of population-level CRC screening.
In-Depth [retrospective cohort]: In this retrospective analysis, participants aged 50 to 70 years old were selected from a fixed cohort of Kaiser Permanente Northern California (KPNC) and Southern California (KPSC) health plan members. A total of 670 841 health plan members met study criteria. In the first round of testing, 5.0% of FIT results were positive, while estimates remained lower but stable in subsequent rounds (3.7% to 4.3% positivity). PPV and FIT sensitivity for CRC were also highest in the first round of testing (51.5% and 84.5%, respectively) and remained lower but stable in rounds 2 through 4 (47.4% to 48% and 73.4% to 78.0%). Furthermore, positive FIT results were associated with a high degree of follow up: 78.4% of patients with positive FIT results had a colonoscopy within 1 year of their test result, and over 96% of participants underwent some degree of follow-up within 12 months of their positive result.
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