FIT screenings linked to 33% lower mortality risk from colorectal cancer
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Key takeaways:
- Completing at least one FIT correlated with 33% lower risk for CRC death overall and 42% lower risk for left colon and rectal cancers.
- Screenings also were linked to lower risk in Asian, Black and white patients.
Completing at least one fecal immunochemical test screening correlated with a 33% overall lower risk for death from colorectal adenocarcinoma, with a 42% reduction reported for cancers in the left colon and rectum, according to researchers.
“FIT screening programs have reported reduced CRC incidence and mortality, but further evidence on effectiveness is limited,” Chyke A. Doubeni, MD, MPH, chief health equity officer at The Ohio State University Wexner Medical Center, and colleagues wrote in JAMA Network Open. “Current trials of FIT have limited power, and/or are not designed to compare FIT screening with unscreened individuals.”
They continued, “Also, there are reasons to believe that FIT effectiveness may vary according to colon site and by race and ethnicity given differences in social and structural barriers that influence care quality across the screening continuum.”
In a nested case-control study, Doubeni and colleagues investigated the association between FIT screening and CRC-related death in 10,711 patients (32.9% aged 60-69 years; 52.1% men; 59.2% white; 18% Hispanic or Latino; 11.7% Asian; 9.1% Black; 2% other) registered in the Kaiser Permanente FIT-based screening program in Northern and Southern California between 2011 and 2017.
Included were 1,103 case patients who died from colorectal adenocarcinoma, as well as 9,608 healthy controls who were alive and had no documented CRC diagnosis on the date of the case’s diagnosis, matched 1:8 by age, sex, health-plan membership duration and geographic location.
The primary outcome was CRC death overall, by tumor location and by race and ethnicity.
The researchers reported that nearly two-thirds of the control population (63.5%) completed at least one FIT screening in the 10 years before the reference date, with a cumulative positivity rate of 12.6%. Of these, 79.4% underwent colonoscopy within 1 year of the result. In the 5 years before the reference date, 44.8% of cases and 55.6% of controls completed at least one FIT screening.
Results from unconditional logistic regression analyses showed that completion of one or more FIT screenings was associated with a 33% reduction in risk for death from overall CRC (adjusted OR = 0.67; 95% CI, 0.59-0.76), as well as a 42% lower risk for death from cancer of the left colon and rectum (aOR = 0.58; 95% CI, 0.48-0.71). There was no “statistically significant difference” in CRC of the right colon.
Further, a completed FIT screening correlated with a 63% mortality risk reduction in Asian patients (aOR = 0.37; 95% CI, 0.23-0.59), a 42% lower risk in Black patients (aOR = 0.58; 95% CI, 0.39-0.85) and a 29% lower risk in white patients (aOR = 0.71; 95% CI, 0.60-0.83). The 22% risk reduction in Hispanic or Latino patients was not significant (aOR = 0.78; 95% 0.57-1.08).
“This population-based, nested case-control study observed that screening with one or more FIT was associated with a lower risk of dying from CRC, particularly for cancers in the left colon and rectum, with benefits observed across the racial and ethnic groups examined,” Doubeni and colleagues wrote. “The findings support the use of strategies for coordinated and equitable large-scale, population-based delivery of FIT screening with follow-up of abnormal screening results to help avert preventable premature CRC deaths.”
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