Occult Blood Test Increases Colon Cancer Screenings

A new study suggests that noninvasive fecal immunochemical tests (FIT) might be more effective in prompting participation in potentially lifesaving colorectal cancer (CRC) screening than colonoscopy, a more expensive and invasive procedure.

Researchers at UT Southwestern (Dallas, TX, USA) and the University of California, San Diego (UCSD, USA) identified 5,970 uninsured (undeserving) patients who were not up to date with CRC screening. Mean patient age was 59 years, and 64% of patients were women. The sample populations was classified as 41% white, 24% black, 29% Hispanic, and 7% other race/ethnicity. The patients were subsequently assigned randomly to three groups.

One group was assigned to FIT outreach, consisting of mailed invitation to use and return an enclosed no-cost FIT (1,593 patients). A second was assigned to colonoscopy outreach, consisting of mailed invitation to schedule a no-cost colonoscopy (479 patients). The third group was assigned to usual care, consisting of opportunistic primary care visit–based screening (3,898 patients). In addition, the FIT and colonoscopy outreach groups received telephone follow-up to promote test completion. The main outcome measures were screening participation in any CRC test within one year.

The results showed that screening participation was significantly higher for both FIT (40.7%) and colonoscopy outreach (24.6%) groups than for usual care (12.1%). On analysis, screening was higher higher for FIT than for colonoscopy outreach among whites, blacks, and Hispanics. Rates of CRC identification and advanced adenoma detection were 0.4% and 0.8% for FIT outreach, 0.4%, and 1.3% for colonoscopy outreach, and 0.2% and 0.4% for usual care, respectively. Eleven of 60 patients with abnormal FIT results did not complete colonoscopy. The study was published in the August 5, 2013, edition of JAMA Internal Medicine.

“The study suggests that the best approach to offering and delivering screening to underserved populations may be through FIT,” said senior author Celette Sugg Skinner, MD, associate director of population science and cancer control at the UT Southwestern Cancer Center. “Questions for the future are whether superior participation can be maintained in the FIT group (because the test must be repeated every year) and how adherence rates will impact overall screening effectiveness and cost.”

FIT is a quick and easy test that requires no special preparation that is used to detect small amounts of occult blood in a patient's stool sample. Completed tests are then mailed to a laboratory for analysis.

Related Links:
UT Southwestern
University of California, San Diego