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Annual fecal immunochemical tests cut costs, need for colonoscopies

In patients at intermediate risk for colorectal cancer, undergoing annual fecal immunochemical tests for surveillance significantly reduced costs and colonoscopies, according to findings published in Gut.

However, fecal immunochemical tests (FITs) may miss some cancers and adenomas, according to the research.

“Colonoscopy surveillance is recommended for patients who remain at increased risk of colorectal cancer following polypectomy,” Amanda J. Cross, PhD, from the department of surgery and cancer at Imperial College London, and colleagues wrote.

While colonoscopy surveillance reduces colorectal cancer incidence, it may be uncomfortable and induce serious complications and anxiety, according to the authors.

“The FIT, widely used for [colorectal cancer] screening, may be an effective alternative to colonoscopy surveillance, but few data are available on FIT in surveillance settings,” they added.

Cross and colleagues conducted a study to determine whether annual FITs reduce surveillance burden on patients and endoscopy services compared with colonoscopy at 3 years. The researchers enrolled 5,938 patients aged 60 to 72 years who were classified as intermediate risk for colorectal cancer after a colonoscopy and recommended to undergo colonoscopy surveillance every 3 years.

Participants were offered FITs at 1, 2 and 3 years post-polypectomy. Those with positive FIT results, defined as having a hemoglobin level of 40 g/g or more, at 1 or 2 years were offered colonoscopy early. The remaining participants were offered colonoscopy at year 3.

Most participants (97%) returned FITs at years 2 and 3.

Over 3 years, the cumulative FIT positivity was 13% at a hemoglobin threshold of 40 g/g. For a lower hemoglobin threshold of 10 g/g, the positivity was higher (29%). Colorectal cancer was diagnosed in 29 patients and advanced adenomas were diagnosed in 446.

The sensitivity of FIT at 3 years was 59% for colorectal cancer and 33% for advanced adenomas at a hemoglobin threshold of 40 g/g and 72% for colorectal cancer and 57% for advanced adenomas at 10 g/g.

The incremental costs per additional advance adenoma and colorectal cancer detected by colonoscopy were approximately $9,309 and $228,668, respectively, compared with FIT.

“If low-threshold annual FIT was implemented instead of 3-yearly colonoscopy, numbers of colonoscopies could be reduced by more than 70% with significant cost savings,” Cross and colleagues concluded. “However, this would come at the cost of missed advanced colorectal neoplasia; depending on the threshold, annual FIT could miss 30% to 40% of [colorectal cancers] and 40% to 70% of advanced adenomas.”

FIT may play a role in postpolypectomy surveillance of patients with intermediate risk for colorectal cancer, but more research and economic analyses are needed to confirm its exact role, according to the researchers. – by Alaina Tedesco

Disclosures: Cross reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.