Fecal Immunochemical Test: A High Yield Colorectal Cancer Screening Tool in Underserved Population

Abstract

Introduction: FIT is a non-invasive method to screen for colonic adenoma and colorectal cancer (CRC). Colonoscopy is the preferred CRC screening test, but wide applicability can be limited by cost, patient acceptability and risks involved especially in underserved population. Methods: The cohort study selected patients who had a colonoscopy to follow up on positive FIT done for CRC screening. Demographics, colonoscopy and pathological findings were reviewed to calculate adenoma, high risk adenoma (HRA) and CRC detection rate. Additionally non-neoplastic findings in FIT positive population were also recorded. All categorical data was summarized as frequencies and percentages and compared using chi-square test. Results: 241 patients had colonoscopies for evaluation of a positive FIT during the study period. The mean age of study population was 60 ± 7 years and 42% (101/240) patients were males. The mean body mass index of the study population was 31 ± 7 kg/m2 with 49% (n=117) patients in obese range. Bowel preparation was adequate in 98% of patients with Boston bowel preparation score of 6 and above. Adenoma detection rate in FIT positive patients was 55% (n=133); of which 22.8% (n=55) were HRA. Adenomas were distributed throughout the colon with 35.68% adenomas in left colon, 24.9% in transverse colon and 22.41% in right colon. Sessile serrated adenoma was found in 1.25% (n=3) patients. CRC was found in 2.49% (n=6). Other findings included diverticulosis in 41.08%, hemorrhoids in 33.61% and angio-vascular malformations in 2.07%. Conclusion: Prescreening patients with FIT can be help in improving the yield of colonoscopy and potentially improve access to colorectal cancer screening in underserved population.