ABSTRACT Background Late diagnosis of colorectal cancer (CRC) remains a public health challenge due to limitations in screening programs. This study evaluated the fecal immunochemical test (FIT) as an alternative screening method for CRC detection. Research design and methods Colonoscopy and immunochemical analysis were used as standard diagnostics. A population-based survey in Kazakhstan assessed disease prevalence and screening outcomes. Diagnostic accuracy and prognostic value of haemoccult testing were analyzed, comparing quantitative and qualitative results. Results Among 6,000 participants, 9.76% (n = 586) had positive FIT results. Elevated fecal hemoglobin concentrations (≥100 µg Hb/g stool) were found in 3.6% (n = 217), while 96.4% (n = 5786) had lower values. Of 150 clinically significant positive cases, 55 were confirmed, including 5 CRC cases and precancerous conditions. FIT facilitated large-scale screening. The Positive Predictive Value (PPV) for qualitative FIT was 10.4%, and for quantitative FIT (≥100 µg Hb/g), it was 15.7%. The Negative Predictive Value (NPV) for qualitative FIT was 100%, and for quantitative FIT, 99.5%. Conclusion FIT demonstrates practical value as an efficient screening tool for early CRC detection, with a weak but significant correlation to histological findings (p < 0.01).

Factors associated with non-adherence to colonoscopy after a positive test in a population-based colorectal cancer screening program.

Computer-aided detection (CAD) systems can enhance adenoma detection, but their effectiveness in high-performance settings and among patients with positive fecal immunochemical test (FIT) results remains uncertain. To evaluate the impact of CAD on adenoma detection in routine practice, focusing on patients with positive FIT results. This multicenter, open-label, randomized clinical trial was conducted at 4 tertiary hospitals in Taiwan from February 23, 2022, to November 27, 2024. Adults aged 40 to 79 years who were scheduled for a colonoscopy owing to FIT positivity, symptoms, screening, or surveillance were randomized 1:1 to CAD-assisted or standard colonoscopy. Data were analyzed from December 1, 2024, to February 28, 2025. Colonoscopy performed with a real-time CAD system or standard high-definition colonoscopy. The primary outcome was adenoma detection rate (ADR), defined as the proportion of patients with at least 1 histologically confirmed adenoma. Secondary outcomes included adenomas per colonoscopy (APC), sessile serrated lesion detection rate (SSLDR), and postpolypectomy surveillance intervals according to the US Multi-Society Task Force (USMSTF) and European Society of Gastrointestinal Endoscopy criteria. Of 1356 randomized participants (mean [SD] age, 60.0 [9.4] years; 678 [50.0%] female and 678 [50.0%] male), CAD-assisted colonoscopy met noninferiority criteria for ADR compared with standard colonoscopy (395 of 675 [58.5%] vs 363 of 681 [53.3%]; absolute difference, 5.2 percentage points [95% CI, -0.1 to 10.5 percentage points]). Superiority was not statistically significant. CAD significantly increased mean (SD) APC (1.41 [1.95] vs 1.20 [1.88]; P = .01), driven mainly by detection of diminutive adenomas. In exploratory analyses of 864 patients with FIT-positive findings, CAD significantly increased ADR (288 of 441 [65.3%] vs 243 of 423 [57.4%]; P = .02; adjusted odds ratio [AOR], 1.39 [95% CI, 1.05-1.86]) and APC (mean [SD], 1.64 [2.08] vs 1.39 [2.09]; P = .01). SSLDR did not differ between groups. Consequently, CAD led to more intensive surveillance recommendations under USMSTF criteria, particularly in patients with FIT-positive findings (58 of 441 [13.2%] vs 31 of 423 [7.3%]; AOR, 1.94 [95% CI, 1.22-3.09]). In this randomized clinical trial, CAD-assisted colonoscopy met noninferiority criteria for adenoma detection. Superiority was not statistically significant overall, with significant improvements limited to the exploratory FIT-positive subgroup, driven largely by diminutive adenomas. CAD also increased intensive surveillance assignments. The incremental benefit of CAD in reducing interval cancer risk requires further investigation. ClinicalTrials.gov Identifier: NCT03842059.

Determinants of colonoscopy adherence after positive colorectal cancer screening: Insights from individual and municipality-level data in Flanders.

Fecal immunochemical test (FIT)-based screening has been recommended as an option for population colorectal cancer (CRC) screening. However, the studies on factors associated with false-positive FIT results are still limited. To identify the clinical and endoscopic factors associated with false-positive results of FIT for advanced neoplasia (AN) and to evaluate whether false-positive FIT results would be indicative of other digestive tract diseases. We prospectively enrolled 929 participants aged 50 years or older at Qilu Hospital of Shandong University between April 2020 and April 2021. The two-sample FIT was used in this study and ≥ 10 μg/g in either of two stool samples was regarded as the positive FIT result. All these participants underwent subsequent gastroscopy and colonoscopy. False positive FIT results were defined as positive FITs without AN detected in colonoscopies. With a cut-off value of 10 µg/g, the positive rate of FIT was 16.0%. For detecting AN, the sensitivity and specificity were 64.6% and 87.6%, respectively. After adjusting confounding factors, male (OR = 1.61; 95% CI, 1.05–2.48; P = 0.030), colorectal inflammation (OR = 2.99; 95% CI, 1.38–6.04; P = 0.003), presence of three or more non-advanced adenomas (OR = 1.78; 95% CI, 1.11–2.82; P = 0.015) and gastric cancer (OR = 11.33; 95% CI, 2.40–59.52; P = 0.002) were associated with higher risk of false-positive FIT results. Although the FIT results may be false-positive for detecting AN, they may still suggest medical issues that warrant closer medical follow-up and intervention. Meanwhile, routine upper endoscopy investigation for false positive patients was not recommended. Upper endoscopy may be considered conditionally in FIT-positive/AN-negative patients with additional risk factors. Large-scale research is required to clarify this issue. (ClinicalTrials.gov ID: NCT04454099) Trial identification number: ClinicalTrials.gov ID: NCT04454099 (URL: https://clinicaltrials.gov/ct2/show/NCT04454099) registered on July 1, 2020.

The National Cancer Screening Program of Korea provides an annual fecal immunochemical test (FIT) for adults aged ≥50 years. We evaluated the diagnostic performance of colonoscopy and the prevalence ratio (PR) of advanced neoplasia (AN) in participants with positive FIT results under the National Cancer Screening Program between 2007 and 2024. The PR of AN was compared between binary groups created based on age, sex, waiting time to colonoscopy, FIT cutoff value, and anemia. Among the 2445 participants with positive FIT results, 1237 (50.6%) underwent colonoscopy. The positive predictive values for non-AN, AN, and sessile serrated lesions were 31.2%, 15.4%, and 14.6%, respectively. The PR of AN was 1.8 times higher in males than in females (P < .001) and 1.9 times higher in the standard FIT cutoff group than in the low FIT cutoff group (P < .001). In the multivariable analysis, male sex (PR = 1.84, 95% confidence interval: 1.36–2.50) and FIT positivity based on the standard cutoff (PR = 1.86, 95% confidence interval: 1.33–2.61) were significantly associated with AN (both P < .001). ANs were more frequently detected in male participants and when the standard FIT cutoff value was used in FIT-based colorectal cancer screening. Given the low colonoscopy completion rate of only 50.6%, colonoscopy completion should be recommended, particularly for male participants and those with positive FIT results based on the standard cutoff value.

ABSTRACTBackgroundThe fecal immunochemical test (FIT) is widely implemented as a first‐line tool in organized colorectal cancer (CRC) screening programs, including Italy. Following a positive FIT, colonoscopy is recommended. Computer‐aided detection (CADe) systems have the potential to enhance adenoma detection, particularly in FIT‐positive populations where identifying advanced adenomas is critical for cancer prevention. This study evaluated the diagnostic performance of CADe‐assisted colonoscopy versus standard colonoscopy (SC) in a FIT‐based screening cohort.MethodsIn this multicenter, randomized controlled trial, patients with a positive FIT result were randomized to undergo either CADe‐assisted or standard colonoscopy. The primary endpoint was the advanced adenoma detection rate (AADR). Secondary endpoints included overall adenoma detection rate (ADR), adenomas per colonoscopy (APC), and mean withdrawal time (WT).ResultsOf 1077 patients enrolled, 68 were excluded due to inadequate bowel preparation, leaving 1009 patients for analysis (CADe: n = 506; SC: n = 503). AADR was comparable between the groups (21.3% vs. 20.5%, p = 0.794). However, CADe significantly improved ADR (67.6% vs. 59.8%, p = 0.012) and APC (1.82 ± 2.12 vs. 1.34 ± 1.81, p < 0.001). Mean WT was longer in the CADe group (17.10 ± 8.28 min vs. 16.13 ± 8.28 min, p = 0.016).ConclusionsIn a FIT‐based organized CRC screening setting, CADe did not enhance detection of AADR with a modest increase in withdrawal time. NCT04441580.

Relevance . Colorectal cancer (CRC) is one of the most common and lethal oncological diseases in Russia. The Yaroslavl region is experiencing a steady increase in incidence, including an alarming trend of rising CRC cases among individuals under 50 years of age (a 56.3 % increase). This underscores the need to develop and implement effective, targeted screening programs, especially for high-risk groups, such as workers in hazardous industries. Objective . To evaluate the effectiveness of a personalized colorectal cancer screening program based on a two-stage method (faecal immunochemical test (FIT) followed by colonoscopy) among workers at an industrial enterprise with increased occupational hazards in the Yaroslavl region. Materials and methods . The study cohort included 1,105 employees of the "YANOS" industrial enterprise aged 38 years and older, classified as a high-risk group for CRC development due to exposure to chemical and physical occupational hazards. Screening was conducted in two stages: I stage — Initial testing using FIT; II stage — colonoscopy for individuals with a positive FIT result (n=136). A set of validated colonoscopy quality indicators was used to assess effectiveness: adenoma detection rate (ADR), advanced adenoma detection rate (AADR), serrated lesion detection rate (SSLR), polyp detection rate (PDR), adenomas per colonoscopy (APC), adenomas per positive patient (APPP), and CRC (colorectal cancer detection rate). A control group of 204 patients was included for comparison. Results . Based on the FIT results, 23.3 % (256 individuals) of all participants tested positive. Overall effectiveness indicators were significantly higher in the FIT-positive group who underwent colonoscopy (n = 136) than in the control group: ADR was 32.4 % vs. 18.1 %, AADR was 27.9 % vs. 18.6 %, and PDR was 50.7 % vs. 37.3 %, respectively. A clear age dependence was identified: in the ≥50 years group, ADR (37.0 %) and AADR (34.5 %) rates were significantly higher than in the &lt;50 years group (25.0 % and 17.3 %, respectively). Key finding: colorectal cancer was diagnosed in 3.7 % of cases in the FIT-positive group (1.9 % in the &lt;50 years group and 4.8 % in the ≥50 years group), whereas no cancer cases were detected in the control group. Conclusions . The personalized two-stage screening program (FIT + colonoscopy) demonstrated high effectiveness for the early detection of precancerous lesions and CRC among workers with occupational risks. Age is a critically important factor: adenoma and advanced adenoma detection rates (ADR, AADR) significantly increase after age 50, confirming the need for age stratification and adaptation of screening intervals. Implementing such targeted programs in regional healthcare systems, especially for high-risk groups (occupational and age-related), is strategically important for reducing CRC mortality through early diagnosis and prevention.

ABSTRACTBackground and AimsWe evaluated the association between Fecal Immunochemical Test (FIT) results and the risk of gastroesophageal cancer (GEC) in a matched cohort, as well as the cost‐effectiveness of a one‐time esophagogastroduodenoscopy (EGD) for individuals who tested FIT‐positive.MethodsWe formed a cohort of individuals aged 50–75 years who underwent FIT testing at Clalit Health in Israel from 2016 to 2019. For each person with a positive FIT result, we matched three individuals with negative results by age, gender, and H. pylori exposure. We used adjusted hazard ratios (adjHRs) to assess the association between a positive FIT result and the risk of GEC within 36 months. We calculated the incremental cost‐effectiveness ratio (ICER) for a one‐time EGD costing USD 350 in individuals who tested positive for FIT, and considered it cost‐effective if below USD 50,000.ResultsThe study included 150,391 individuals (47.6% female, median age 62.4 years). During follow‐up, 202 cases of GEC were recorded: 0.17% in FIT‐positive individuals (64/37,709) and 0.12% in FIT‐negative individuals (138/112,682), adjHR 1.39 (95% CI 1.03–1.87). GEC was also associated with H. pylori exposure (adjHR 1.43, 95% CI 1.08–1.90) and immigration from high‐risk countries. A one‐time EGD demonstrated favorable cost‐effectiveness across various scenarios, with an ICER of USD 25,535/QALY.ConclusionsThis matched‐cohort study suggests that individuals with a positive FIT may have an increased risk of GEC, comparable to that of established high‐risk populations. Adding a one‐time EGD to colonoscopy for FIT‐positive individuals may be a cost‐effective approach for healthcare systems that can accommodate such interventions.

Background:Early colorectal cancer (CRC) detection helps reduce the mortality rate. This study aimed to investigate colon lesions in individuals with positive and negative fecal immunochemical test (FIT) results among the (PERSIAN) Guilan cohort study (PGCS) population.Methods:This cross-sectional study was conducted on 1158 participants over 50 who were volunteers for the FIT stool test at the Endoscopy Department of Razi Hospital, Rasht, Iran, from 2021 to 2022. The FIT test was screened for all participants, and for 172 individuals (86 individuals from each group with positive and negative FIT results), a colonoscopy was performed to investigate the colon lesions. Demographic/clinical characteristics, FIT results, colonoscopy findings, and the Bristol Stool Chart were completed. All data were analyzed using SPSS Version 16, considering a significant level<0.05.Results:Out of 1,158 participants, 86 had positive FIT results, and 172 (52.3%) were females. The colonoscopy results showed that 34.3% of the patients had colon lesions. Individuals with positive FIT exhibited a significantly higher prevalence of colon lesions (p<0.001). No statistically significant differences were observed between positive and negative FIT results, demographic and clinical characteristics, and the location of lesions in individuals with colon lesions (p>0.05). Moreover, there was a significant difference in pathological findings and the presence of adenomatous polyps regarding the FIT results (p<0.001).Conclusion:The effectiveness of FIT in the initial stages of screening for early lesion detection is considerable, especially for individuals with upper age.

Abstract Purpose: Early-onset colorectal cancer (EOCRC) incidence is rising in a predominantly symptomatic population of young adults. Effective triage tools are needed to identify high-risk individuals in this relatively low incidence population. We examined fecal immunochemical test (FIT) use among adults ages &amp;lt;50 with red flag signs and symptoms for EOCRC and evaluated whether FIT use is predictive of EOCRC risk. Methods: Retrospective cohort study of US Veterans (ages 18-49) receiving Veterans Health Administration (VHA) care during 1999-2022 with a documented EOCRC red flag sign or symptom (abdominal distension, abdominal pain, anemia [non-specific and iron-deficiency], change in bowel habits, constipation, diarrhea, hematochezia, nausea/vomiting) based on International Classification of Diseases, 9th (ICD-9) or 10th (ICD-10) Revision codes, or lab results. The primary exposure was FIT uptake and result, documented via lab results, shown as a three-level variable (no FIT use, negative FIT or positive FIT). The primary outcome was EOCRC diagnosis, derived from linkages to the VA Oncology Domain and National Death Index. Covariates included age at symptom presentation, sex, race and ethnicity, and number of symptoms within 60 days of first symptom presentation. Participants entered the study at first symptom onset and were followed until the first of: incident or fatal EOCRC diagnosis, non-EOCRC-related death, 2 years follow-up, age 50 or December 31, 2022. We derived cumulative CRC incidence estimates using Kaplan-Meier estimation. Multivariable, mixed-effects Cox regression models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for CRC risk among those who received a FIT test. Results: Among 751,116 Veterans, 38,019 (5.1%) received a FIT. The most common symptoms yielding a FIT were abdominal pain (29.6%), anemia (20.4%), hematochezia (18.5%), and diarrhea (16.4%). Approximately 76% of patients who received a FIT had one symptom at presentation. Among 38,019 patients who received a FIT, 6,191 (16.3%) had a positive finding. Approximately 1,295 (21%) of 6,191 FIT-positive patients received a diagnostic colonoscopy compared to 46,693 (6.6%) of 713,097 non-FIT patients. After two years of follow-up, patients with a positive FIT had a 1.44% cumulative EOCRC incidence (95% CI: 1.12%-1.77%), compared to a 0.12% among those with a negative FIT (95% CI; 0.08%-0.16%) and 0.12% among those who did not receive a FIT (95% CI: 0.12%-0.13%). The findings correspond to an aHR for EOCRC of 12.81 (95% CI: 8.47-19.36) for FIT-positive patients compared to those with a negative FIT. Conclusions: Among adults ages 18-49 presenting with a red flag sign or symptom to VHA care, FIT use was low. However, a positive FIT result was linked to a substantially elevated EOCRC risk relative to a negative result. To address potential concerns about generalizability, future research should confirm whether systematic use of FIT as a clinical triage tool could help identify symptomatic adults at high EOCRC risk who need a diagnostic colonoscopy. Citation Format: Daniel Sabater Minarim, Kylie Morgan, Lin Liu, Matthew P. Banegas, Maria Elena Martinez, Samir Gupta, Josh Demb. FIT for red flag signs and symptoms of early onset colorectal cancer: low value or viable diagnostic tool? [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: The Rise in Early-Onset Cancers—Knowledge Gaps and Research Opportunities; 2025 Dec 10-13; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(23_Suppl):Abstract nr PR014.

The fecal immunochemical test (FIT) is indicated for colon cancer screening in asymptomatic average-risk patients. However, the inclusion of orders for non-indication-based FITs in medical records has led to increased inappropriate use in emergency department (ED) and inpatient settings. This study aimed to evaluate the clinical impact of FIT results when the test is used for purposes other than routine screening. We conducted a single-center, retrospective chart review using electronic medical records, analyzing patients who underwent the FIT in the ED or while admitted to the VA Hospital from September 2013 through December 2016. The collected data included demographics; clinical symptoms and signs; medications; and information on digital rectal examinations, gastroenterology consultations, and endoscopic procedures. Of the 1,354 patients included, most were men. Among FIT-positive patients, the mean age was 73.7 years. The majority of FITs were done in the ED. Positive FIT results were statistically significantly associated with rectal bleeding, weakness, and diarrhea. Anticoagulants were associated with positive FIT results. Patients with positive tests often received gastroenterology consultations and were more likely to undergo endoscopic procedures. None of the evaluated FITs were used for screening, confirming that they had been ordered inappropriately. This indiscriminate use can lead to unnecessary interventions and prolonged hospitalizations. Additionally, negative tests may lead to underestimate worrisome symptoms or features that require further investigation. In conclusion, our study does not support the indiscriminate use of the FIT in inpatient or ED settings.

Depending on the colorectal cancer (CRC) screening programme, a colonoscopy should be performed within 1-3 months after a positive faecal immunochemical test (FIT) result. However, such short timescales may be difficult to meet and seem trivial when most CRCs take years to develop. To assess the impact of time to colonoscopy on CRC outcomes. This French nationwide retrospective cohort study included individuals with a positive FIT result between 2016 and 2019 and a subsequent colonoscopy performed within 24 months. The risks of CRC, advanced-stage CRC and advanced adenoma (AA) according to time interval to colonoscopy were assessed and evaluated on individual and socio-geographic characteristics. Overall, 374 113 FIT-positive individuals underwent post-FIT colonoscopy (86.6% compliance rate), with 21 616 CRCs and 122 359 AAs diagnosed. Compared with the 2-3 months interval class, no increased risk of CRC, advanced-stage CRC or AA was observed after 3 months up to 24 months, with adjusted odds ratio after 12 months at 0.93 (0.95 CI 0.83 to 1.03), 1.04 (0.85 to 1.25) and 0.88 (0.82 to 0.93), respectively. Individuals with high faecal haemoglobin concentrations (f-Hb ≥200 µg/g) were respectively eight, eleven and two times more likely to have a CRC, an advanced-stage CRC or an AA as compared with the 30-40 µg/g class. No increased risk of CRC, advanced-stage CRC or AA was observed up to 24 months. Our findings suggest that ensuring colonoscopy compliance after a positive FIT may take precedence over rigid adherence to interval. The higher the f-Hb, the sooner the colonoscopy should be performed.

Guaiac fecal occult blood test (gFOBT) is often used to evaluate evidence of food protein-induced allergic proctocolitis (FPIAP) in children in primary care and gastroenterology settings; however, it has not been validated for this diagnosis, and little is known about the positivity rates in early infancy. In this study, we used samples from healthy asymptomatic infants aged two weeks to two months to evaluate the gFOBT positivity rate compared to those diagnosed with FPIAP. This was a nested case-control study. Frozen stool samples from infants aged two days to five months enrolled in the Gastrointestinal Microbiome and Allergic Proctocolitis study were evaluated using gFOBT (n = 123). The results were interpreted by three blinded staff members, including a trained clinical research coordinator, a pediatric gastroenterologist, and an experienced medical assistant. Additionally, the samples were analyzed using a quantitative fecal immunochemical test (FIT) for hemoglobin to compare with gFOBT results. Eight percent of samples from the 100 healthy asymptomatic infants were gFOBT positive (11% when including positive and equivocal results). Seventy-four percent of samples from infants diagnosed with FPIAP were gFOBT positive. The interrater reliability of gFOBT interpretation was 81%. Of the healthy samples that yielded a positive gFOBT result, 50% also yielded a positive FIT result. Of the 23 FPIAP samples that yielded a positive gFOBT result, 29% yielded a positive FIT result. Healthy asymptomatic infants in early infancy were gFOBT positive up to 11% of the time. Caution should be used when interpreting gFOBT results in young infants in a diagnostic setting.

BackgroundThe fecal immunochemical test (FIT) is a diagnostic modality for colorectal cancer (CRC) screening, with the US Multisociety Task Force setting an 80% adherence benchmark for follow-up colonoscopy (FUC). Guidelines recommend that FITs be performed only in the context of CRC screening.MethodsOur study is a retrospective review of all patients with positive FIT records from 2018 to 2023. Patient characteristics, FIT ordering practices, and clinical settings were collected. The compliance rates with FUC, colonoscopy diagnostic yield, and adenoma detection were analyzed, and adherent and nonadherent patients were compared via univariate and logistic regression analyses.ResultsA total of 1424 patients had positive FIT results, with ages ranging between 18 and 92 years. Among the 1424 patients, 245 (17.2%) were < 45 years (group 1), 829 (52.9%) were 45–75 years (group 2), and 350 (24.6%) were > 75 years (group 3). In group 2, 241 (16.9%) tests were conducted for CRC screening. Seven hundred and three (49.3%) positive FIT tests, including tests for abdominal pain and anemia, were carried out for diagnostic purposes. Only 618 (43.3%) patients with positive FIT results underwent FUC, of whom 277 (44.8%) had adenomas and 28 (4.5%) were diagnosed with CRC. Bivariate analysis revealed that age, fewer comorbidities, prior colonoscopy, family history of CRC, diagnostic FIT, and outpatient setting increased FUC adherence. Multivariate analysis revealed that age and outpatient setting were predictive factors.ConclusionAlthough FITs are used for CRC screening, our study found a discrepancy between guidelines and real-world practice. Compliance with FUC after a positive FIT is below the optimal range, with adherence decreasing with age.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12876-025-04455-0.

BackgroundThe Faecal Immunochemical Test (FIT) is a cornerstone in both colorectal cancer (CRC) screening programs and referral pathways for symptomatic patients. The test identifies haemoglobin in stool and, when present, is used as a referral indicator on the suspected CRC pathway. Since its introduction, the number of referrals with a positive FIT has risen, stretching diagnostic capabilities to the limit. This study examines whether the value of the result is significant and, if so, can be used as part of the triage process.MethodsThis retrospective cohort study analysed patients who underwent FIT as part of a CRC screening program between June 2020 and November 2021 in Wrightington, Wigan and Leigh NHS Foundation Trust. A total of 293 patients contributed clinical data, including FIT scores, presenting symptoms, and diagnostic outcomes. The patients were stratified according to ranges of FIT scores (<10, 11-50, 51-100, 101-150, 151-200, >400). Their correlating outcomes, including the presence of cancer, benign findings (e.g., polyps and diverticular disease), and inflammatory conditions (e.g., colitis), were recorded.ResultsOut of the 293 patients included in the study, 223 were FIT-positive and 70 FIT-negative, with 20 refusing investigations in the FIT-negative group and six in the FIT-positive group.Among the investigated patients, 25 were diagnosed with CRC; all cases were in the FIT-positive group, and none were found in the FIT-negative group. The sensitivity of FIT for CRC detection was 100% (95% CI: 86.7-100%), and the negative predictive value (NPV) was 100% (95% CI: 94.8-100%), confirming FIT's strength as a rule-out test in this cohort. The positive predictive value (PPV) of a positive FIT result for CRC was 11.2% (95% CI: 7.4-15.9%).Of the 25 cancers, 13 (52%) had a FIT value of >400, and five (20%) had a FIT value of 11-50. In this cohort, 76% of CRC were in the sigmoid or rectum, with 63% of these cases associated with FIT values >400 and 15% falling within the lower FIT range of 11-50.For the remaining FIT-positive patients without cancer, 123/198 (62.1%) had a FIT value of 11-50. Of these, 63 (51.2%) had either a polyp, diverticular disease, or colitis. Of the remaining cancer-negative patients, 30/198 (15.2%) had a FIT value of >400, of which 22 (73%) had benign pathology. When symptoms were analysed, most patients had a change in bowel habit, with rectal bleeding being the most typical symptom in the cancer group.ConclusionsFIT is used widely to aid referral for investigating symptoms suggestive of bowel cancer. As more patients are being referred with positive FIT, there is a need to try to rationalise investigations. The premise of this study was to determine whether a low FIT value corresponded with a low chance of finding a cancer in symptomatic patients, thus aiding the triage process, reducing the numbers having unnecessary investigations, and relieving the burden on endoscopy units.In this particular study, none of the FIT-negative patients had bowel cancer, confirming FIT's strong rule-out performance. However, as 20% of cancers occurred among patients with low-positive FIT results (11-50 µg/g), clinicians should remain cautious in interpreting low values as entirely reassuring. While most cancers were seen with FIT >400, PPV remained low overall (~11%), and high FIT scores did not always indicate malignancy.

Background:Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality globally. Early detection through Fecal Immunochemical Test (FIT) screening is essential, particularly among at-risk populations. However, evidence linking dietary consumption behavior to FIT test outcomes remains limited in Thailand, especially in the southern region. This study aimed to determine the prevalence of positive FIT results and to examine the association between dietary consumption behavior and sociodemographic factors with positive FIT results among at-risk individuals in Southern Thailand. Materials and Methods:A cross-sectional analytic study was conducted among participants aged 50–70 years who underwent FIT screening in primary healthcare units in Nakhon Si Thammarat Province between October 2023 and August 2024. Totally, 382 participants were included, 191 cases with positive- and 191 controls with negative-FIT results. The case-control ratio was 1:1. Data were collected using structured questionnaires assessing demographic characteristics, health risk factors, and dietary consumption behaviors. Crude and multivariate logistic regression analyses were performed to identify factors associated with a positive FIT result. Results:The prevalence of positive FIT results was 13.77% (95% CI: 12.04–15.66). Multivariate analysis showed low dietary consumption behavior was prevalent (83.77%), it was not significantly associated with FIT positivity (AOR = 1.10, 95%CI: 0.71-1.68), after adjusting for confounders. However, lower education level (AOR = 0.50, 95%CI: 0.32-0.78), agricultural occupation (AOR = 0.45, 95%CI: 0.25-0.82), and monthly income between 3,000–8,000 Baht (AOR = 2.11, 95%CI: 1.27-3.49) were significantly associated with a positive FIT result. Conclusion:Education, occupation, and income were significantly associated with positive FIT results. Targeted education and risk-reduction strategies are recommended to improve CRC screening outcomes in at-risk populations.

Guidelines now recommend initiating colorectal cancer (CRC) screening at age 45 years rather than 50 years, but little is known about screening completion and yield among people aged 45 to 49 years. To evaluate fecal immunochemical test (FIT) completion and yield in patients aged 45 to 49 versus 50 years. Retrospective cohort study. Kaiser Permanente Northern California, Washington, and Colorado. Those distributed a FIT kit during January to September 2022. FIT completion within 3 months, FIT positivity, receipt of colonoscopy within 3 months after a positive FIT result, and colonoscopy yield. A total of 267 732 FIT kits were distributed: 213 928 (79.9%) to patients aged 45 to 49 years, and 53 804 (20.1%) to those aged 50 years. Overall, FIT completion was slightly higher in patients aged 45 to 49 years (38.9% vs. 37.5%; adjusted risk ratio [aRR], 1.05 [95% CI, 1.04 to 1.06]), although at Colorado, those aged 45 to 49 years were substantially less likely to complete a FIT (30.7% vs. 40.2%; aRR, 0.77 [CI, 0.73 to 0.80]). Overall, FIT positivity was lower in patients aged 45 to 49 years (3.6% vs. 4.0%; aRR, 0.91 [CI, 0.84 to 0.98]), and receipt of colonoscopy after a positive FIT result was similar between groups (64.9% vs. 67.4%; aRR, 1.00 [CI, 0.94 to 1.05]). Adenoma detection was lower in the younger group (58.8% vs. 67.7%; aRR, 0.88 [CI, 0.83 to 0.95]). Yields were similar for adenoma with advanced histology (13.2% vs. 15.9%; aRR, 0.86 [CI, 0.69 to 1.07]), polyp with high-grade dysplasia (3.4% vs. 5.1%; aRR, 0.68 [CI, 0.44 to 1.04]), sessile serrated lesion (10.3% vs. 11.7%; aRR, 0.92 [CI, 0.71 to 1.21]), and CRC (2.8% vs. 2.7%; aRR, 1.10 [CI, 0.62 to 1.96]). The small number of neoplasia events contributed to wide CIs. Similar FIT completion and yield rates in people aged 45 to 50 years support initiation of CRC screening at age 45 years. Kaiser Permanente Sidney R. Garfield Memorial Fund.

BackgroundRectal bleeding is a frequent symptom, with causes ranging from benign conditions to serious diseases like colorectal cancer (CRC) and inflammatory bowel disease (IBD). In the UK, the two-week wait (2WW) referral pathway, which includes the fecal immunochemical test (FIT), plays a key role in triaging suspected CRC cases. This study evaluates the effectiveness of flexible sigmoidoscopy (FS) in detecting significant bowel pathologies (SBPs) in FIT-positive patients with isolated rectal bleeding.MethodsWe reviewed records of 344 patients with isolated rectal bleeding and a positive FIT result, referred to the 2WW pathway at York and Scarborough Teaching Hospitals NHS Foundation Trust from February to December 2023. All patients underwent colonoscopy. Findings from colonoscopy were used as a standard to compare with the expected reach of FS. Pathologies were categorized into SBPs (cancer, IBD, polyps ≥10 mm) and non-SBPs, and the location of SBPs in relation to the splenic flexure was also assessed.ResultsThe average age of patients was 61.58 years. Significant bowel pathology (SBP) was identified in 89 of 344 (25.9%) patients, including 16 (18%) patients with cancer, 21 (23.6%) patients with IBD, and 52 (58.4%) patients with large polyps. All cases of cancer and IBD were found distal to the splenic flexure, while 21.1% (11/89) of large polyps were proximal. Higher FIT values (>100 µg Hb/g feces) and older age were significantly associated with SBPs. However, age and higher FIT values did not predict whether SBPs were proximal or distal.ConclusionFor FIT-positive patients with isolated rectal bleeding, FS can serve as an effective initial diagnostic tool. Patients without detected cancer can be downgraded from the fast-track pathway to routine colonoscopy follow-up to avoid missing proximal premalignant lesions. This approach enhances resource utilization while ensuring comprehensive patient care. Further studies are needed to improve triage criteria and diagnostic accuracy within the 2WW pathway.

In Isfahan, the fecal immunochemical test (FIT) has been used since January 2016 as part of the Iran's Package of Essential Non-communicable Diseases (IraPEN) program for colorectal cancer (CRC) screening. The test is recommended for people who are 50-70 years old. Then, those with positive results would be referred for colonoscopy. This study aims to describe the uptake of the program and its outcome. A retrospective observational study was performed by collecting data from Isfahan Vice-Chancellor for Health database for this study purpose. The number of participators, the number of positive FIT, and the number of detected polyps or cancers were determined. Between 2016 and 2019, the number of participants in the program reached 345 207 individuals (nearly 40% of the eligible population of 874 674). Totally, 21 264 participants (6.1%) had positive tests, of whom about 20% underwent the recommended colonoscopy with available reports, and 971 (24%) and 110 (3%) patients were diagnosed with polyps and CRC, respectively. Over four years of screening with FIT in Isfahan, 40% of the eligible population participated. Among those with positive FIT results, 20% underwent colonoscopy, and approximately 26% of these individuals were identified as having polyps or cancer. This study provides valuable insights into the uptake and outcomes of a population-based CRC screening program in Isfahan, Iran. The findings highlight the need for targeted interventions to increase participation rates and improve the detection of polyps and CRC cases.