Colonoscopy versus Fecal Immunochemical Testing in Colorectal-Cancer Screening
Summary (1 min read)
Methods
- Controlled trial involving asymptomatic adults 50 to 69 years of age, the authors compared one-time colonoscopy in 26,703 subjects with FIT every 2 years in 26,599 subjects.
- The primary outcome was the rate of death from colorectal cancer at 10 years.
- This interim report describes rates of participation, diagnostic findings, and occurrence of major complications at completion of the baseline screening.
- Study outcomes were analyzed in both intention-to-screen and as-screened populations.
Conclusions
- Subjects in the FIT group were more likely to participate in screening than were those in the colonoscopy group.
- The New England Journal of Medicine Downloaded from nejm.org at UNIVERSIDAD AUTONOMA DE MADRID RECTORADO on October 30, 2014.
- Stool tests for occult blood (guaiac testing and fecal immunochemical testing [FIT]) are predominantly used in Europe and Australia, whereas colonoscopy is the predominant screening method in the United States.
- The procedure is recommended as a first-line screening test on the basis of indirect data and observational studies.
- The authors hypothesized that FIT screening every 2 years would be noninferior to one-time colonoscopy with respect to a reduction in mortality related to colorectal cancer among average-risk subjects.
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Citations
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Cites background from "Colonoscopy versus Fecal Immunochem..."
...Mortality reduction was significant for distal CRC, but not proximal CRC. CRC incidence was reduced by 21%....
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...Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years....
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...Sensitivity for single-sample FIT ranges from 73% to 92%, and specificity ranges from 91% to 97%.102,109-112 However, most brands of FIT have limited evidence demonstrating their accuracy for detection of CRC. Daly et al found published data from colonoscopyconfirmed studies of FIT performance for only 6 of the 26 versions of FIT sold in the United States.113 Because studies have shown variable performance of different FITs across studies in which individuals undergo multiple tests to compare outcomes,114-116 it should not be assumed that versions of FIT that lack published data have suitable performance characteristics.117 The original, low-sensitivity guaiac tests have largely been superseded by HSgFOBT and FIT in organized screening programs around the world, and a similar shift is underway in the United States.102,118-120 National surveys of CRC screening test utilization do not distinguish between FIT and gFOBT, but overall use of stool testing in the United States is low....
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...This recommendation for CRC screening in averagerisk adults is based on the GDG’s judgment of the preponderance of benefits of CRC screening over harms, the overall quality of the evidence on screening outcomes, recent evidence related to the incidence of disease, evidence demonstrating the influence of test preference on adherence to recommendations, and the high value individuals place on preventing and avoiding death from CRC.51,52 The GDG chose to issue a general overall recommendation for CRC screening rather than recommendations for the use of specific individual tests....
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...Since 2008, evidence has accumulated on the different screening modalities, test performance in population-based screening programs, and the changing risk of CRC.(3,25,26) This guideline update is based on an assessment of the underlying burden of disease; the strength of evidence and the balance of benefits and harms for available screening tests; and consideration of patient values and preferences, including the importance of choice in the selection of screening test options....
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References
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Frequently Asked Questions (11)
Q2. What are the future works mentioned in the paper "Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening" ?
Org february 23, 2012706 where do the authors stand and what is the future ?
Q3. What are the two methods of colorectal cancer screening?
Colonoscopy and fecal immunochemical testing (FIT) are accepted strategies for colorectal-cancer screening in the average-risk population.
Q4. What is the common method of screening for colorectal cancer?
Stool tests for occult blood (guaiac testing and fecal immunochemical testing [FIT]) are predominantly used in Europe and Australia, whereas colonoscopy is the predominant screening method in the United States.
Q5. how many years of FIT screening would be considered a noninferior test?
The authors hypothesized that FIT screening every 2 years would be noninferior to one-time colonoscopy with respect to a reduction in mortality related to colorectal cancer among average-risk subjects.
Q6. How much is the rate of death associated with colonoscopy?
In a cohort of average-risk subjects, the use of screening colonoscopy was associated with a reduction in the incidence of colorectal cancer of 67% and a reduction in the rate of death of 65%.
Q7. What are the three main categories of tests for colorectal cancer?
Recommended strategies for colorectal-cancer screening fall into two broad categories: stool tests (occult blood and exfoliated DNA tests) and structural examinations (flexible sigmoidoscopy, colonoscopy, and computed tomographic colonography).
Q8. How many subjects were found to have colorectal cancer?
Colorectal cancer was found in 30 subjects (0.1%) in the colonoscopy group and 33 subjects (0.1%) in the FIT group (odds ratio, 0.99; 95% confidence interval [CI], 0.61 to 1.64; P = 0.99).
Q9. What is the accurate test for colorectal cancer?
Although data from randomized studies evaluating the effect of colonoscopy on the rate of death from colorectal cancer are lacking, the procedure is recommended as a first-line screening test on the basis of indirect data and observational studies.
Q10. What is the effective method for detecting colorectal cancer?
Population-based case–control studies have suggested that colonoscopy markedly reduces the risk of colorectal cancer7,8 and death.9
Q11. What is the name of the study?
All rights reserved.n engl j med 366;8 nejm.org february 23, 2012698Colorectal cancer is the third most common cancer worldwide and the second leading cause of cancer-related deaths.