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Colorectal neoplasia yield similar for FIT every 1, 2 or 3 years

Clinical Question:
What is the best interval for fecal immunochemical testing as a screening test for colorectal cancer?

Bottom Line:
There appears to be no advantage to obtaining fecal immunochemical testing (FIT) more often than every 3 years. (LOE = 1b)

Reference:
van Roon AH, Goede SL, van Ballegooijen M, et al. Random comparison of repeated faecal immunochemical testing at different intervals for population-based colorectal cancer screening. Gut 2013;62(3):409-415.  [PMID:22387523]

Study Design:
Randomized controlled trial (nonblinded)

Funding:
Government

Allocation:
Concealed

Setting:
Population-based

Synopsis:
FIT is a way to screen for colorectal cancer (CRC), and even in these days of widespread colonoscopy, many patients refuse colonoscopy so alternatives remain important. Although FIT has a better yield than older guaiac-based tests, repeated rounds of screening are necessary because of limited sensitivity of the test. In this study, 10,698 Dutch residents were invited to participate in a trial comparing 4 strategies: a single round of screening using 2 FITs, or a single FIT at baseline and a second one either 1, 2 or 3 years later. (There is currently no formal CRC screening program in the Netherlands.) Approximately 62% of patients responded to the invitation for screening. In the 3 groups that received a single initial FIT, 8.4% of patients had a positive test result, and 3.3% had advanced neoplasia (CRC or an adenoma that was at least 10 mm, more than 25% villous histology, or had evidence of dysplasia). In the group that got a pair of FITs at the initial visit, 12.7% of patients had a positive test result and 4.1% had advanced neoplasia. The key finding is that at the second visit, there was no difference between the 1-, 2-, and 3-year interval groups regarding percentage attendance for screening, percentage with a positive test result, or percentage with advanced neoplasia (1.7% to 2.1%).Of 32 CRCs detected in the entire population (based on linkage to a cancer registry), 29 were screen detected, 22 of them during the initial round. Better participation in the second round of screening was noted for patients in the biennial and triennial screening intervals compared with those who underwent annual screening.

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