AGA SectionRecommendations on Fecal Immunochemical Testing to Screen for Colorectal Neoplasia: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer
Section snippets
Literature Review
The committee relied on 2 previous systematic reviews of the FIT. The first was developed for the US Preventive Services Task Force,15 and the second addressed the sensitivity of FIT for CRC.16 To update this review, a search strategy similar to that used for the more recent review16 was used to identify high-quality reports published since August 2013 through September 30, 2015. The updated review used the MEDLINE (Ovid) and Cochrane Database Search strategy as outlined by Lee et al16 in their
How sensitive and specific is FIT-based screening for CRC and advanced neoplasia with one-time application?
Several cohort and cross-sectional studies analyzed the single-application test characteristics of FIT for CRC detection with or without a comparative guaiac-based fecal occult blood test (gFOBT), using colonoscopy or at least 2 years of follow-up evaluation as the reference standard19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 (Table 1). In a meta-analysis of 19 studies in asymptomatic average-risk adults the pooled sensitivity of FIT was 79% (95% confidence
gFOBT vs FIT
Studies using different designs (eg, randomized controlled trial [RCT], cross-sectional) have compared gFOBT and FIT for the detection of neoplasia in screening populations (Table 4).19, 20, 21, 28, 33, 35, 53, 54, 55, 56, 57, 58 Significant variation exists across studies with the specific brands used (both gFOBT and FIT) and outcomes examined. Studies have indicated that FIT is superior to gFOBT in sensitivity for detecting CRC and advanced neoplasia, with comparable or only slightly reduced
Number of samples
The number of FIT samples needed for test completion (eg, from a single bowel movement vs multiple bowel movements across days) is an important consideration for optimizing CRC screening. In a Dutch study, van Roon et al75 examined participation and clinical outcomes with 1 or 2 FITs (OC-Sensor, Eiken Chemical Co, Tokyo, Japan; cut-off value, 10 μg/g). There was no difference in participation, but 2-sample FIT was associated with a higher detection rate of advanced neoplasia (4.1% [95% CI,
Acknowledgments
The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government or the Department of Veterans Affairs.
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Conflicts of interest This authors discloses the following: David A. Johnson is a clinical investigator for Exact Sciences and Epigenomics. David Lieberman served on scientific advisory Board for Exact Sciences. Douglas K. Rex received consulting fees from Olympus and research support from Endochoice. Douglas J. Robertson is on the scientific advisory board for Medtronic. Tonya Kaltenback served as Consultant for Olympus America. The remaining authors disclose no conflicts.
This article is being published jointly in Gastroenterology, American Journal of Gastroenterology, and Gastrointestinal Endoscopy.
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Authors share co-first authorship.