Are Repeated FITs an Equivalent Alternative to Colonoscopy?
(HealthDay News) — Repeated annual fecal immunochemical tests (FITs) can detect all colorectal cancer (CRC) cases and may be equivalent to colonoscopy in detecting advanced neoplasia in first-degree relatives of patients with CRC, according to a study published in the November issue of Gastroenterology.
Enrique Quintero, MD, PhD, from Universidad de La Laguna in Spain, and colleagues randomized (1:1) 1,918 first-degree relatives of patients with CRC to receive a single colonoscopy examination (782 individuals) or three FITs (784 individuals; one/year for three years; using a cut-off ≥10µg hemoglobin/g feces). An equivalency of the strategies was defined by a difference of the 95% confidence interval for the detection of advanced neoplasia of ±3%.
The researchers found that advanced neoplasia was detected in 4.2% of the FIT group and 5.6% of the colonoscopy group (odds ratio, 1.41; 95% confidence interval, 0.88–2.26; P=0.14). In the FIT group, 3.9% of the first-degree relatives had advanced neoplasia, as did 5.8% in the colonoscopy group (odds ratio, 1.56; 95% confidence interval, 0.95–2.56; P=0.08). While FIT did not miss CRC, it missed 16 of 41 advanced adenomas. Compared to the colonoscopy strategy, endoscopic evaluation was required in four-fold fewer individuals using the FIT strategy.
"Repeated FIT screening (one/year for three years) detected all CRCs and proved equivalent to colonoscopy in detecting advanced neoplasia in first-degree relatives of patients with CRC," the authors write. "This strategy should be considered for populations where compliance with FITs is higher than with colonoscopy."