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Colorectal Cancer: FIT Twice a Year After 50

Recent research data published in the September issue of Clinical Gastroenterology and Hepatology confirms that an annual or biennial fecal immunological test (FIT) beginning at age 50 years in combination with a single colonoscopy at age 66 years is as effective as current colorectal cancer (CRC) screening guidelines. Moreover, the hybrid screening strategy requires fewer resources than the current CRC screening protocol. The findings are consistent with a recent US Preventive Services Task Force analysis.
The authors compared the hybrid screening strategy with single-modality screening using annual FIT, sigmoidoscopy every 5 years, and colonoscopy every 10 years. They also considered hybrid screening strategies, including annual FIT of patients aged 50 to 65 years and then a single colonoscopy at age 66 years (FIT/COLOx1).

They found that all of the evaluated screening strategies improved outcomes and reduced the costs of CRC compared with no screening. The authors acknowledge that the accuracy of the model prediction is dependent on assumptions about test performance.

They report that a change in the screening interval from 1 to 2 years did not significantly reduce the benefits of hybrid screening. However, adherence to colonoscopy at age 66 years was critical to maintaining the effectiveness of the hybrid screening program.

Traditionally, FIT uses a cutoff threshold of 100 ng hemoglobin (Hb)/mL, but the authors suggest a threshold of 50 ng Hb/mL may be optimal.

“We estimated the sensitivity and specificity of FIT with a 50 ng Hb/mL cutoff from limited data available at the time of the analysis. Increasing the sensitivity and decreasing the specificity of FIT by using a 50 ng Hb/mL cutoff led to modest increases in the [quality-adjusted life-years] gains and cost savings of FIT/COLOx1. Most interestingly, FIT/COLOx1 that used a 50 ng Hb/mL cutoff outperformed screening by colonoscopy in both health benefits and costs,” the authors write.

Comment by LabFlorida

FIT and other colorectal cancer tests are available at our Tampa-based lab.