Screening by Fecal immunochemical test reduces colorectal cancer-related mortality: JAMA

A new study by Chyke Doubeni and team found that completing fecal immunochemical test (FIT) was related with a decreased chance of mortality from colorectal cancer (CRC), especially in the left colon. The findings of this study were published in the Journal of American Medical Association.

One of the leading causes of cancer-related fatalities globally is CRC, which is expected to have diagnosed 1,52,810 people in the US and claimed 53,010 lives in 2024. To lower the risk of mortality from CRC, the US Preventive Services Task Force and other US organizations advise yearly fecal immunochemical test screening for those at average risk. FIT is easy to use, typically done at home without a face-to-face consultation, and is amenable to conventional analysis. This study determined if FIT screening was linked to a decreased risk of CRC mortality in general.

The participants who passed away from colorectal adenocarcinoma between 2011 and 2017 and were between the ages of 52 and 85 were eligible for this study. The cases were matched in a 1:8 ratio based on age, sex, length of time spent in a health plan and geographic area with randomly chosen individuals who were alive and free of colorectal cancer on the date of the case's diagnosis (controls).

This cohort of 2,127,128 persons yielded a total of 10,711 participants, which included a total of 1103 cases and 9608 controls. During the 10-year period before the reference date, 6101 (63.5%) controls completed one or more FITs, resulting in a cumulative 12.6% positive rate (768 controls), with 610 (79.4%) having a colonoscopy within one year. Over a 5-year period, 494 patients (44.8%) and 5345 controls (55.6%) completed one or more FITs. The regression analysis for completing one or more FIT screenings was linked to a 33% reduced risk of dying from CRC and a 42% lower risk in the rectum and left colon.

There was no link to right colon cancer, although the difference in estimates between the right colon and the left colon or rectum was statistically relevant. The FIT screening was related with a decreased risk of CRC mortality among non-Hispanic Asians, non-Hispanic Blacks and non-Hispanic Whites. Overall, the findings encourage the implementation of techniques for large-scale population-based FIT screening, including follow-up on abnormal screening results to help avoid needless early CRC deaths.

Source:

Doubeni, C. A., Corley, D. A., Jensen, C. D., Levin, T. R., Ghai, N. R., Cannavale, K., Zhao, W. K., Selby, K., Buckner-Petty, S., Zauber, A. G., Fletcher, R. H., Weiss, N. S., & Schottinger, J. E. (2024). Fecal Immunochemical Test Screening and Risk of Colorectal Cancer Death. In JAMA Network Open (Vol. 7, Issue 7, p. e2423671). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.23671