Randomized Trial of Colonoscopy vs. FIT: Interim Results

Douglas K. Rex, MD

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In This Article

Abstract and Introduction

Abstract

Analyses of first-round screening show higher adherence to FIT, similar detection and yield of cancer, and higher adenoma detection rates and complications with colonoscopy.

Introduction

Controversy continues about whether the best approach to colorectal cancer screening is colonoscopy or noninvasive testing with fecal occult blood testing.

To investigate further, researchers randomized patients aged 50 to 69 in Spain to undergo one-time colonoscopy or fecal immunochemical testing (FIT) every 2 years. Of 27,792 patients invited to undergo colonoscopy, 5649 (20.3%) accepted. Of 27,642 patients invited to undergo FIT, 9353 (33.8%) accepted. Colorectal cancer was found in 30 patients in the colonoscopy group and 33 in the FIT group (0.1% of each group using intent-to-screen analysis). Advanced adenoma detection rates were 1.9% in the colonoscopy group and 0.9% in the FIT group. Nonadvanced adenoma detection rates were 4.2% in the colonoscopy group and 0.4% in the FIT group. Among patients who actually underwent the screening tests, the yield of cancer was similar in the colonoscopy and FIT groups (0.5% and 0.3%); the yield of advanced adenomas was 9.7% versus 2.4% (P<0.001); and the yield of nonadvanced adenomas was 22.1% versus 1.1% (P<0.001). Complications occurred in 24 patients in the colonoscopy group and 10 patients in the FIT group.

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