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

Study design: Randomized controlled trial (nonblinded)

Funding: Government

Setting: Outpatient (any)

Reviewer

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA


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Comments

Roland Michael Grad

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.

ARUP KUMAR DHARA

Impact assessment

Excellent

Anonymous

COLONOSCOPY AND YEARLY FECAL-BASED BLOOD TESTING

GOOD INFORMATIONS

Anonymous

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.

Anonymous

colonic health

none at this time

Anonymous

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.

Anonymous

CRCS

Colonoscopy is much more expensive.