In adults aged 50 to 69 y, invitation to screening with FIT was noninferior to invitation for colonoscopy for colorectal cancer mortality at 10 y
A recent Spanish study finding that more patients responded to invitations to fecal immunochemical testing (FIT) than colonoscopy was methodologically robust, but higher acceptance of colonoscopy in the U.S. might affect extrapolation of the findings, an ACP Journal Club commentary said.
A Spanish trial called COLONPREV compared responses to invitations for a colonoscopy (n=28,708) or a fecal immunochemical test (FIT) (n=28,696) among average-risk patients ages 50 to 69 years. It found that FIT was noninferior to colonoscopy on the outcome of colorectal cancer (CRC) mortality at 10 years, with rates of 0.22% and 0.24%, respectively. The authors noted that ongoing randomized trials may provide more information on this comparison.
The study was published on April 12 by The Lancet. The following commentary by John F. Cox III, MD, FACP, was published in the ACP Journal Club section of Annals of Internal Medicine on July 1.
CRC is projected to cause about 52,900 deaths in the USA in 2025. Observational studies indicate that both FIT and colonoscopy reduce CRC incidence and mortality, with colonoscopy being more effective.
COLONPREV by Castells and colleagues found higher participation rates for FIT invitations than for colonoscopy invitations, with both methods being equally effective in reducing CRC mortality. The trial, conducted in Spain, used a programmatic screening approach and was methodologically robust due to its randomized design, large sample size, repeated outreach, minimal loss to follow-up, and 10-year follow-up. Screening rates in COLONPREV were low—40% for FIT invitations and 32% for colonoscopy invitations. The acceptance of screening colonoscopy might be higher in North America than in Spain, potentially affecting extrapolation of these findings.
Increasing participation in CRC screening is crucial for saving lives. Education on the benefits and strategies to reduce barriers, such as electronic medical record reminders and patient navigator programs, is essential. I will continue to recommend colonoscopy but also consider FIT or multitarget stool DNA tests for patients who are reluctant or do not follow through with colonoscopy, as the best screening test is the one that the patient completes.