Fecal Immunochemical Testing for Colorectal Cancer Screening in Average Risk Individuals: Fit for Detecting Neoplasia?

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Purpose: Fecal immunochemical testing (FIT) is comprised of antibodies that detect the intact globin portion of human hemoglobin. FIT has an advantage over colonoscopy in its ease of use, and may increase patient compliance with colorectal cancer (CRC) screening. However, FIT is still a test of occult blood (even if more sensitive than guaiac testing), and may be positive from sources in the colon or rectum other than cancers or adenomas. Also, bleeding from adenomas occurs infrequently; thus the potential for CRC prevention through adenoma detection and removal is likely to be lower than with colonoscopy. We examined an average risk population undergoing CRC screening to evaluate the frequency of significant colonic neoplasia in patients with a positive FIT test. Methods: We retrospectively reviewed data from patients who participated in the New York State Department of Health Program with FIT testing (Immunochemical Fecal Globin, Quest Diagnostics) for CRC screening performed at our hospital. As part of this program, the FIT test kits are provided free of cost to the patient, and if the test is positive, the individual may then undergo a colonoscopy, paid for by the Department of Health. The primary outcome was detection of colorectal neoplasia. The secondary outcome was the detection of adenomatous polyps. Results: 243 asymptomatic, average risk individuals underwent FIT testing (222 negative and 21 positive). Twenty (of 21) patients have since undergone colonoscopy (one patient has not yet been scheduled). The mean age of the patients was 59 (range 50-71) years; 12 patients were female and eight were male. 12 patients were Asian, eight were Hispanic, three were Caucasian, and one was African-American. No cancers were diagnosed in our patients. Advanced adenomas were detected in 20% of patients (4/20). All patients had internal hemorrhoids, five patients had diverticulosis, and one patient had inflammatory bowel disease diagnosed at colonoscopy. Conclusion: In an average risk population undergoing CRC screening, positive FIT testing was associated with advanced adenomas in 20% of patients, while 80% of patients were found to have other sources of bleeding, including hemorrhoids, diverticulosis and colitis. Positive FIT testing did not aid in detection of colorectal neoplasia in our patients.

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