Fecal Immunochemical Test (FIT) May Be a Simple, Cost-Effective Alternative to Colonoscopy
January 13, 2011
Even though colorectal cancer is the second-leading cause of cancer death among men and women, many people who are at risk for the disease are not being screened, according to the Centers for Disease Control and Prevention (CDC).
However, one noninvasive test for colorectal cancer, the fecal immunochemical test or FIT, may help increase screening rates and, as a result, reduce the number of deaths from cancers of the rectum or colon. It also has the advantage of being relatively inexpensive when compared to more invasive tests like a colonoscopy or flexible sigmoidoscopy.
Researchers analyzed a hypothetical group of 100,000 people ages 50 to 75 at average risk for colorectal cancer. A computer model developed outcomes for these people using seven different screening methods (FIT, colonoscopy, flexible sigmoidoscopy, two different fecal DNA tests, computed tomographic colonography also known as CTC or virtual colonoscopy, and fecal occult blood testing or FOBT) and no screening at all.
The model also examined medical and non-medical costs associated with each screening choice, including the performance of test procedures, a patient's travel for care, and colorectal cancer treatment (if needed). Their study was published in the online journal PLoS Medicine.
The FIT method was revealed as the most cost-effective screening method: "Among a cohort of 100,000 average risk individuals followed until death, 4,857 cancers and 1,782 cancer-related deaths would be expected with no screening," the study authors wrote. "An annual FIT with high sensitivity for cancer (81%) and moderate sensitivity for advanced adenomas (54%) could reduce costs and decrease the number of [colorectal cancers] and cancer-related deaths to 1,393 and 457, respectively."
One reason for the superiority of FIT, according to the researchers, is the fact that the test is given annually; by contrast, colonoscopy is typically performed every 10 years.
There are advantages and disadvantages to all screening tests for colorectal cancer, but the researchers noted that unlike other tests and procedures, FIT does not require any dietary restrictions or bowel preparation. Additionally, FIT can be performed at home, has no risk of complications such as bleeding or infection, and does not require sedation.
Sources: Heitman, et al. "Colorectal Cancer Screening for Average-Risk North Americans: An Economic Evaluation." PLoS Medicine, published online Nov 23, 2010. PLoS Med 7(11): e1000370. doi:10.1371/journal.pmed.1000370; American Cancer Society; and Centers for Disease Control and Prevention