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

Letters16 July 2019Why What You May Not Know About Fecal Immunochemical Testing MattersJames Allison, MDJames Allison, MDUniversity of California, San Francisco, San Francisco, California (J.A.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0266 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Swartz's statement that FIT performs poorly at adenoma detection has been expressed previously (1). The assertion reveals a still-too-common misunderstanding of organized FIT-based screening programs. These programs do not rely on the sensitivity of a 1-time application of FIT (application sensitivity) but instead recommend and promote repeated annual testing (as is done in the United States). Only approximately 6% of all polyps become cancer, and the dwell time from benign polyp to cancer is slow: Annual FIT thus allows many opportunities to detect and remove those polyps most likely to become cancer.This lack of knowledge about ...References1. Bretthauer M, Kalager M. Colonoscopy as a triage screening test [Editorial]. N Engl J Med. 2012;366:759-60. [PMID: 22356330] doi:10.1056/NEJMe1114639 CrossrefMedlineGoogle Scholar2. Levin B, Lieberman DA, McFarland B, 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 Scholar3. Young GP, Symonds EL, Allison JE, et al. Advances in fecal occult blood tests: the FIT revolution. Dig Dis Sci. 2015;60:609-22. [PMID: 25492500] doi:10.1007/s10620-014-3445-3 CrossrefMedlineGoogle Scholar4. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112:1016-30. [PMID: 28555630] doi:10.1038/ajg.2017.174 CrossrefMedlineGoogle Scholar5. Levin TR, Corley DA, Jensen CD, et al. Effects of organized colorectal cancer screening on cancer incidence and mortality in a large community-based population. Gastroenterology. 2018;155:1383-91. [PMID: 30031768] doi:10.1053/j.gastro.2018.07.017 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of California, San Francisco, San Francisco, California (J.A.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0301. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoWhy What You May Not Know About Fecal Immunochemical Testing Matters James Allison Why What You May Not Know About Fecal Immunochemical Testing Matters Andrew W. Swartz Metrics 16 July 2019Volume 171, Issue 2Page: 151-152KeywordsAdenomasCancer preventionCancer screeningColonoscopyColorectal cancerDisclosureMortalityResearch designScreening guidelines ePublished: 16 July 2019 Issue Published: 16 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...