Outlook: Colonoscopy Versus Fecal Testing in Colorectal Cancer Screening

An interim report of a randomized, controlled trial involving asymptomatic adults aged 50 to 69 years comparing one-time colonoscopy (n = 26,703) with fecal immunochemical testing (FIT) every 2 years (n = 26,599) as a screening test for colorectal cancer was recently published.¹ The primary end point of the study was defined as the rate of death from colorectal cancer at 10 years.

Interim results show that the rate of participation was higher in the FIT group than in the colonoscopy group (34.2% vs 24.6%, P <.001). Colorectal cancer was found in 30 subjects (0.1%) in the colonoscopy group and 33 subjects (0.1%) in the FIT group (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.61-1.64; P = .99). Advanced adenomas were detected in 1.9% in the colonoscopy group compared with 0.9% in the FIT group (OR, 2.30; 95% CI, 1.97-2.69; P <.001), and nonadvanced adenomas were detected in 4.2% in the colonoscopy group and 0.4% in the FIT group (OR, 9.80; 95% CI, 8.10- 11.85; P <.001).

This interim analysis shows that subjects in the FIT group were more likely to participate in screening than were those in the colonoscopy group. Additionally, the numbers of subjects in whom colorectal cancer was detected were similar in the 2 study groups.

Dr. Reed received her doctor of pharmacy degree from the University of the Sciences in Philadelphia, Pennsylvania, and currently works as a medical editor in the greater Philadelphia area.

References:

1. Berg WA, Zhang Z, Lehrer D, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 2012;307(13):1394-1404.

2. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes [published online ahead of print March 26, 2012]. N Engl J Med. 2012;366(17):1567-1576.

3. Wegwarth O, Schwartz LM, Woloshin S, Gaissmaier W, Gigerenzer G. Do physicians understand cancer screening statistics? a national survey of primary care physicians in the United States. Ann Intern Med. 2012;156(5):340-349.

4. Avery AJ, Rodgers S, Cantrill JA, et al. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis [published online ahead of print February 21, 2012]. Lancet. 2012;379(9823):1310-1319.