Why What You May Not Know About Fecal Immunochemical Testing Matters
Authors: James Allison
Journal: Annals of Internal Medicine (2019)

Editorials5 March 2019Why What You May Not Know About Fecal Immunochemical Testing MattersJames Allison, MDJames Allison, MDUniversity of California, San Francisco, San Francisco, California, and Kaiser Permanente Northern California Division of Research, Oakland, California (J.A.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0301 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Some U.S. primary care physicians and many of their patients may be unaware that fecal immunochemical tests (FITs) are noninvasive, easy to prepare, and inexpensive and have effectiveness similar to that of colonoscopy when used in a consistent, programmatic fashion to screen for colorectal cancer (CRC) (1). The paucity of studies comparing FITs and colonoscopy in 2000 may have been why Podolsky advocated for insurers to cover colonoscopic screening in all average-risk persons aged 50 years or older (2). Shortly thereafter, Congress ordered Medicare to cover the procedure without requiring published evidence of its superiority over less invasive and cheaper ...References1. Robertson DJ, Lee JK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2017;152:1217-1237. [PMID: 27769517] doi:10.1053/j.gastro.2016.08.053 CrossrefMedlineGoogle Scholar2. Podolsky DK. Going the distance—the case for true colorectal-cancer screening [Editorial]. N Engl J Med. 2000;343:207-8. [PMID: 10900282] CrossrefMedlineGoogle Scholar3. Berkowitz Z, Zhang X, Richards TB, Nadel M, Peipins LA, Holt J. Multilevel small-area estimation of colorectal cancer screening in the United States. Cancer Epidemiol Biomarkers Prev. 2018;27:245-53. [PMID: 29500250] doi:10.1158/1055-9965.EPI-17-0488 CrossrefMedlineGoogle Scholar4. Weinberg DS, Barkun A, Turner BJ. Colorectal cancer screening in the United States: what is the best FIT? Ann Intern Med. 2017;166:297-8. [PMID: 27776358]. doi:10.7326/M16-2341 LinkGoogle Scholar5. Imperiale TF, Gruber RN, Stump TE, Emmett TW, Monahan PO. Performance characteristics of fecal immunochemical tests for colorectal cancer and advanced adenomatous polyps. A systematic review and meta-analysis. Ann Intern Med. 2019;170:319-29. doi:10.7326/M18-2390 LinkGoogle Scholar6. Knudsen AB, Zauber AG, Rutter CM, Naber SK, Doria-Rose VP, Pabiniak C, et al. Estimation of benefits, burden, and harms of colorectal cancer screening strategies: modeling study for the US Preventive Services Task Force. JAMA. 2016;315:2595-609. [PMID: 27305518] doi:10.1001/jama.2016.6828 CrossrefMedlineGoogle Scholar7. Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2017;153:307-23. [PMID: 28600072] doi:10.1053/j.gastro.2017.05.013 CrossrefMedlineGoogle Scholar8. Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al; American Cancer Society Colorectal Cancer Advisory Group. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570-95. [PMID: 18384785] doi:10.1053/j.gastro.2008.02.002 CrossrefMedlineGoogle Scholar9. Allison JE, Fraser CG. The importance of comparing quantitative faecal immunochemical tests (FIT) before selecting one for a population-based colorectal cancer screening programme. J Lab Precis Med. 2018;3:7. doi:10.21037/jlpm.2018.01.05 CrossrefGoogle Scholar10. Allison JE, Fraser CG, Halloran SP, Young GP. Population screening for colorectal cancer means getting FIT: the past, present, and future of colorectal cancer screening using the fecal immunochemical test for hemoglobin (FIT). Gut Liver. 2014;8:117-30. [PMID: 24672652] doi:10.5009/gnl.2014.8.2.117 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of California, San Francisco, San Francisco, California, and Kaiser Permanente Northern California Division of Research, Oakland, California (J.A.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0301.Corresponding Author: James Allison, MD, Division of Gastroenterology, Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, Room 3D, San Francisco, CA 94110; e-mail, james.[email protected]edu.This article was published at Annals.org on 26 February 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPerformance Characteristics of Fecal Immunochemical Tests for Colorectal Cancer and Advanced Adenomatous Polyps Thomas F. Imperiale , Rachel N. Gruber , Timothy E. Stump , Thomas W. Emmett , and Patrick O. Monahan Why What You May Not Know About Fecal Immunochemical Testing Matters Andrew W. Swartz Why What You May Not Know About Fecal Immunochemical Testing Matters James Allison Metrics Cited byLow Rate of Cancer Detection by Colonoscopy in Asymptomatic, Average-Risk Subjects with Negative Results From Fecal Immunochemical TestsWhy What You May Not Know About Fecal Immunochemical Testing MattersAndrew W. Swartz, MDColorectal Cancer Screening 5 March 2019Volume 170, Issue 5Page: 342-343KeywordsColonoscopyColorectal cancerDisclosureFood and Drug AdministrationGlobinsHematologic testsHemoglobinResearch laboratoriesSpecificitySystematic reviews ePublished: 26 February 2019 Issue Published: 5 March 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...