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Once-and-done screening colonoscopy has higher rates of adherence than yearly fecal-based blood testing
Clinical Question
Are patients more likely to participate in colonoscopy or yearly fecal occult blood testing to screen for colon cancer?
Bottom line
A single screening colonoscopy had higher rates of participation than 5 years of fecal occult blood testing in this study of patients offered free screening (84% vs 73%; P ≤ .001). After 5 years, only 38.4% of participants assigned to fecal occult blood testing completed all the recommended yearly testing. As a result, advanced neoplasia or large serrated lesions were more likely to be identified by colonoscopy than testing. 1b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Government
Setting: Outpatient (any)
Synopsis
These researchers enrolled 3523 healthy volunteers, recruited from 3 sites in the United States, who were between the ages of 40 years and 69 years. The participants were randomized, using concealed allocation to receive one no-cost colorectal cancer screening by colonoscopy or annual high-sensitivity guaiac-based fecal occult blood tests (HSgFOBTs) using the Hemoccult II SENSA kit for 5 years. The participants were an average of 55.5 years and most (75%) identified as White. From the start, more people completed colonoscopy screening as compared with HSqFOBT: 84% versus 73% (P ≤ .001). Adherence to all 5 years of HSqFOBT screening was accomplished by only 38.4% of participants, with one-quarter of these participants switching to colonoscopy screening. Using intention-to-treat analysis, adenomas or serrated lesions were identified in 22.7% of the screening colonoscopy arm and 12.2% of the HSqFOBT arm (P < .001). Advanced neoplasia or large serrated lesions were identified in 8.2% of participants who received initial colposcopy (per-protocol analysis). Of the patients who completed the first round of HSqFOBT screening, 4.0% had a positive finding, and 91.4% of these participants followed up with colonoscopy.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
This screening trial did not address a good question
Screening colonoscopy is simply not feasible at the population level. Screening for colon cancer requires a well organized government run program supported by Public Health.
Impact assessment
Excellent
COLONOSCOPY AND YEARLY FECAL-BASED BLOOD TESTING
GOOD INFORMATIONS
A study that promotes a higher cost test with more risk to p
Why not find ways to increase adherence to the lower cost and lower-risk test, rather than simply state that colonoscopy has higher rates of adherence? Perhaps the commentary could point that out. From this study alone one might have concluded that colonoscopy is better, since it catches more cancers. A fairer comparison would look at differences in detection between equivalent rates of screening colonoscopy and stool testing. Also, as a minor point colonoscopy is referred to as colposcopy in one instance in the synopsis.
colonic health
none at this time
FIT versus colonoscopy for CRC screening
This compared annual FIT to colonoscopy. Annual FIT is not the recommendation (q2-3 years); colonoscopy is not readily available unless you already meet criteria for blood in stool (eg rectal bleeding, positive FIT) or first degree relative with colon cancer). So this study, though interesting, isn't really applicable where I am.
CRCS
Colonoscopy is much more expensive.