Similar rates of FIT completion support commencing colorectal cancer screening at age 45
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Key takeaways:
- Younger vs. older patients achieved a higher rate of fecal immunochemical test completion overall (38.9% vs. 37.5%).
- They further experienced decreased screening positivity (3.6% vs. 4%).
Similar rates of fecal immunochemical test completion and colonoscopy yields among patients aged 45 to 49 vs. 50 years supported updated guidelines which recommend the initiation of colorectal cancer screening at an earlier age.
“In issuing qualified recommendations for an earlier start to CRC screening, organizations have acknowledged that few data are available on screening completion and outcomes in people aged 45 to 49 years,” Theodore R. Levin, MD, from the division of research at Kaiser Permanente Northern California, and colleagues wrote in Annals of Internal Medicine. “In response to the call to initiate earlier CRC screening, Kaiser Permanente implemented screening starting at age 45 years in most regions by offering mailed and office visit-based [fecal immunochemical test (FIT)] kit distribution through organized CRC screening programs, in addition to opportunistic colonoscopy.”
In a retrospective cohort study, Levin and colleagues investigated rates of FIT completion and coloscopy yield among 267,732 patients (50.5% women; 39.5% white) aged 45 to 50 years from Kaiser Permanente Northern California (80.7%), Washington (9.7%) and Colorado (9.5%) health systems. Patients were divided into two cohorts: aged 45 to 49 years (79.9%) and aged 50 years (20.1%). Additional studied outcomes included the rate of FIT positivity and receipt of follow-up colonoscopy within 3 months following a positive FIT result.
All patients received FIT kits between January and September 2022.
Results demonstrated a “slightly higher” rate of FIT completion overall among younger (38.9%) vs. older (37.5%) patients which corresponded with an adjusted risk ratio of 1.05 (95% CI, 1.04-1.06). The researchers observed similar results among men (37.3% vs. 35.7%; aRR = 1.06; 95% CI, 1.04-1.08) and women (40.4% vs. 39.4%; aRR = 1.04; 95% CI, 1.03-1.06) as well as Asian (47.7% vs. 44.9%; aRR = 1.07; 95% CI,1.04-1.09) and white (42.4% vs. 40.4%; aRR = 1.06; 95% CI, 1.04-1.08) patients but not those of “other” race (28% vs. 36.3%; aRR = 0.78; 95% CI, 0.62-0.97).
They further noted younger patients at Kaiser Permanente Colorado were “substantially less likely” to complete FIT (30.7% vs. 40.2%; aRR = 0.77; 95% CI, 0.73-0.8). Levin and colleagues noted this lower rate of completion “may be explained” by an electronic health records care gap which disproportionately referred younger patients for colonoscopy when FIT was not yet available to this population.
According to results, younger patients experienced decreased FIT positivity (3.6% vs. 4%; aRR = 0.91; 95% CI, 0.84-0.98) and adenoma detection (58.8% vs. 67.7%; aRR = 0.88; 95% CI, 0.83-0.95) but similar rates of colonoscopy within 3 months following a positive FIT result (64.9% vs. 67.4%; aRR = 1; 95% CI, 0.94-1.05). Yields for adenoma with advanced histology (13.2% vs. 15.9%; aRR = 0.86; 95% CI, 0.69-1.07), polyp with high-grade dysplasia (3.4% vs. 5.1%; aRR = 0.68; 95% CI, 0.44-1.04), sessile serrated lesion (10.3% vs. 11.7%; aRR = 0.92; 95% CI, 0.71-1.21) and CRC (2.8% vs. 2.7%; aRR = 1.1; 95% CI, 0.62-1.96) were similar between groups.
“FIT completion and yields in patients aged 45 to 49 years approached rates observed in
those aged 50 years,” Levin and colleagues wrote. “These findings support recent guideline recommendations to initiate CRC screening at age 45 years and can inform efforts to implement earlier FIT-based CRC screening.”
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