Though fecal immunochemical testing (FIT) is preferred by many for the
screening of colorectal cancer, a higher number of precancerous and cancerous
lesions are detected using colonoscopy, according to a recent study published
in the New England Journal of Medicine.
Screening for Colorectal cancers is done to detect two types of lesions:
Cancerous lesions and polyps which might prove to be cancerous or later turn
cancerous.
The non-invasive tests for the detection of colorectal cancer include the Fecal
Immunochemical testing (FIT), fecal occult blood testing (FOBT) and stool DNA
testing. The more invasive screening tests include colonoscopy, sigmoidoscopy and
barium enema.
The fecal immune-chemical testing (FIT) is a non-invasive test which includes
an at-home collection of stool samples, which are then lab tested mainly for
detection of the presence of any blood in the feces. Blood in the feces is not always
visible with naked eyes and is thus tested chemically. The presence of blood
may be suggestive of a cancerous lesion in the colorectal area. However, feces
can test positive for blood even due to other causes such as gastrointestinal
bleeding, ulcers, adverse drug reaction, use of NSAIDS etc.
Colonoscopy is an invasive method of detection where a long tube with a small
camera at the end is inserted through the anus into the colon and the areas of
colon are viewed on the screen. The procedure usually is done with the help of sedatives
in order to reduce the discomfort to the patient. Areas of abnormal growth in
the colon can be removed for testing during this procedure. A more clear and
elaborate view of small and big cancerous growths is obtained with this procedure.
A positive outcome of fecal-immunochemical testing (FIT) usually calls for a
detailed testing with colonoscopy. This is done with the aim to precisely
detect the presence of colorectal cancer (if any) and the extent of its spread.
A recent study compared colonoscopy with FIT in the screening of colorectal
cancer amongst the average-risk population.
Published in the New England Journal of Medicine, the study was conducted on
adults between the age group of 50-69 years who were free of any symptoms of
colorectal cancer. A comparison was made between 26,703 adults screened once
for colorectal cancer using colonoscopy with 26,599 adults who were screened
using FIT every two years.
The incidence of colorectal cancer was found similar in both the study groups.
But the researchers observed a higher rate of participation amongst the group
tested using FIT. It was noted that advanced adenomas were detected in more
than twice the number of patients undergoing colonoscopy than the group
screened using FIT. Non-advanced lesions were found four times more commonly in
the colonoscopy group compared to the FIT group.
The researchers of the study concluded that a higher participation rate was
seen amongst the group undergoing FIT. Though the number of cases of colorectal
cancer detected was similar in both the groups, a higher number of adenomas
were found in the group undergoing colonoscopy.
In another independent study conducted in Netherlands, FIT was found to be a
more cost-effective method than FOBT for the detection of colorectal cancer.
But a higher haemoglobin cut-off level was recommended for patients undergoing
FIT when the capacity to perform colonoscopy is limited. It was also
recommended that a colonoscopy should be performed in all cases detected with
adenomas.