Screening With Fecal Immunochemical Test More Impactful for Distal Than Proximal Cancers
Douglas K. Rex, MD, MASGE, reviewing Chiu HM, et al. Gut 2021 Jan 25.
In a nationwide biennial fecal immunochemical test (FIT) screening program in Taiwan, more than 5.4 million individuals were invited to undergo screening between 2004 and 2009 and followed through 2014. The rate of completing at least one FIT was 56.6%, and 52.3% of the participants completed more than 1 test. The positivity rate was 7% in the first round and 6.4% in subsequent rounds, and 70% of FIT-positive patients had diagnostic evaluations, 90% of which were by colonoscopy.
After adjustments, advanced-stage colorectal cancer was reduced by 34% overall, and mortality was reduced by 40% after FIT screening. Mortality was reduced by 28% in the proximal colon and 44% in the distal colon. FIT sensitivity was 63% for all proximal cancers and 73% for distal cancers.
COMMENTThese results are informative regarding the impact of FIT screening on proximal versus distal cancers, although the finding of higher sensitivity for distal cancer is not new. Once again, we are reminded to ensure that patients with positive FIT results undergo colonoscopy.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Chiu HM, Jen GH, Wang YW, et al. Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers. Gut 2021 Jan 25. (Epub ahead of print) (http://dx.doi.org/10.1136/gutjnl-2020-322545)
