Intelligent Use of the Fecal Immunochemical Test in Population-Based Screening
Authors: Stephen P. Halloran
Journal: Annals of Internal Medicine (2018)

Editorials2 October 2018Intelligent Use of the Fecal Immunochemical Test in Population-Based ScreeningStephen P. Halloran, MBE, MScStephen P. Halloran, MBE, MScUniversity of Surrey, Surrey, United Kingdom (S.P.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2257 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Population screening for colorectal cancer (CRC) is an exercise in risk assessment that balances benefits and harms within available endoscopy resources. Although missed disease in a patient with symptoms might be labeled an “error,” missed pathology in population-based screening is inevitable and varies with the performance characteristics of the screening intervention. Nationwide population-based CRC screening programs are fast becoming the norm, with the quantitative fecal immunochemical test (FIT) replacing the guaiac fecal occult blood test as the method of choice. In their Annals report, Selby and colleagues (1) describe a large community-based initiative that uses FIT.Screening with FIT, which ...References1. Selby K, Jensen CD, Lee JK, Doubeni CA, Schottinger JE, Zhao WK, et al. Influence of varying quantitative fecal immunochemical test positivity thresholds on colorectal cancer detection. A community-based cohort study. Ann Intern Med. 2018;169:439-47. doi:10.7326/M18-0244 LinkGoogle Scholar2. American Cancer Society. American Cancer Society guideline for colorectal cancer screening. Accessed at www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html on 14 August 2018. Google Scholar3. Bretthauer M, Kalager M, Weinberg DS. From colorectal cancer screening guidelines to headlines: beware! Ann Intern Med. 2018. [PMID: 29987330]. doi:10.7326/M18-1720 LinkGoogle Scholar4. Cooper JA, Parsons N, Stinton C, Mathews C, Smith S, Halloran SP, et al. Risk-adjusted colorectal cancer screening using the FIT and routine screening data: development of a risk prediction model. Br J Cancer. 2018;118:285-293. [PMID: 29096402] doi:10.1038/bjc.2017.375 CrossrefMedlineGoogle Scholar5. Cooper JA, Moss SM, Smith S, Seaman HE, Taylor-Phillips S, Parsons N, et al. FIT for the future: a case for risk-based colorectal cancer screening using the faecal immunochemical test. Colorectal Dis. 2016;18:650-3. [PMID: 27135192] doi:10.1111/codi.13365 CrossrefMedlineGoogle Scholar6. Moss S, Mathews C, Day TJ, Smith S, Seaman HE, Snowball J, et al. Increased uptake and improved outcomes of bowel cancer screening with a faecal immunochemical test: results from a pilot study within the national screening programme in England. Gut. 2017;66:1631-1644. [PMID: 27267903] doi:10.1136/gutjnl-2015-310691 CrossrefMedlineGoogle Scholar7. Stegeman I, de Wijkerslooth TR, Stoop EM, van Leerdam ME, Dekker E, van Ballegooijen M, et al. Combining risk factors with faecal immunochemical test outcome for selecting CRC screenees for colonoscopy. Gut. 2014;63:466-71. [PMID: 23964098] doi:10.1136/gutjnl-2013-305013 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Surrey, Surrey, United Kingdom (S.P.H.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2257.Corresponding Author: Stephen P. Halloran, MBE, MSc, 15, Heron Shaw, Cranleigh, Surrey GU6 8BT, United Kingdom; e-mail, s.[email protected]ac.uk.This article was published at Annals.org on 18 September 2018. 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Levin, MD, and Douglas A. Corley, MD, PhDParticipation in a population-based screening for colorectal cancer using the faecal immunochemical test decreases mortality in 5 years 2 October 2018Volume 169, Issue 7Page: 496-497KeywordsAdenomasCancer screeningEndoscopyPositive predictive valueQuality adjusted life yearsQuestionnairesRetrospective studiesRisk assessmentsRisk managementSpecificity ePublished: 18 September 2018 Issue Published: 2 October 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...