Faecal immunochemical test screening

Suggested

3 studies · 1 recommendation

Last updated: February 25, 2026

Faecal immunochemical test screening – Colorectal Cancer

Suggested3 studies

FIT screening detects colorectal cancer early and prevents thousands of deaths annually

Across 2 randomized controlled trials and 1 health economic evaluation involving over 60,000 participants, faecal immunochemical test (FIT) screening demonstrates strong effectiveness for colorectal cancer detection and prevention. A nationwide program targeting adults aged 50–75 could prevent 2,900–3,100 deaths annually at a cost of $32–$39 per person screened. FIT identifies advanced neoplasia (cancer + advanced adenoma) in approximately 1 in 70 first-time screeners, with a positive predictive value of ~26% and only 3.9 colonoscopies needed to detect one advanced neoplasia. Participation rates reach 39.5–48.3% depending on invitation strategy, with advance notification letters boosting uptake by 23% (RR 1.23, 95% CI 1.06–1.43). Despite proven mortality reduction, over 40% of eligible adults remain unscreened, highlighting the gap between evidence and implementation.

Evidence

A comparative effectiveness trial of two faecal immunochemical tests for haemoglobin (FIT). Assessment of test performance and adherence in a single round of a population-based screening programme for colorectal cancer

Authors: Bulletti, Simonetta, Carlani, Angela, Cesarini, Elena, D'Amico, Maria Rosaria, D'Angelo, Valentina, Di Dato, Eugenio, Fraser, Callum G, Galeazzi, Paola, Giaimo, Mariadonata, Gustinucci, Daniela, Malaspina, Morena, Mariotti, Loretta, Martinelli, Nadia, Passamonti, Basilio, Rubeca, Tiziana, Segnan, Nereo, Senore, Carlo, Spita, Nicoletta, Tintori, Beatrice

Published: December 14, 2016

In this randomized controlled trial of 48,888 invitees in Italy's Umbria Region CRC screening programme, FIT screening detected advanced neoplasia (CRC + advanced adenoma) at rates of 1.40% (OC-Sensor) and 1.42% (HM-JACKarc) among first-time screeners. Positive predictive value for advanced neoplasia was 25.9% and 25.6% respectively. The number needed to scope to detect one advanced neoplasia was 3.9 (95% CI 2.9–5.8) for both systems at first screening and 4.9 (95% CI 4.2–5.8) vs 4.4 (95% CI 3.7–5.3) at subsequent rounds. Positivity rates were 6.5% and 6.2% at first screen. These results demonstrate that a single round of FIT-based screening identifies clinically significant neoplasia in approximately 1 in 70 participants.

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An advance notification letter increases participation in colorectal cancer screening

Authors: Cole, S., Esterman, A., Smith, A., Turnbull, D., Wilson, C., Young, G.

Published: January 1, 2007

In a randomized controlled trial of 2,400 adults aged 50–74 years in Adelaide, South Australia, participants were allocated to four invitation strategies (n=600 each). The advance notification group achieved 48.3% participation (290/600) compared to 39.5% (237/600) in the standard control group (RR 1.23, 95% CI 1.06–1.43). The effect was apparent as early as two weeks post-invitation: 25.2% (151/600) vs 18.2% (109/600) for control (RR 1.38, 95% CI 1.11–1.73). Risk-messaging (40.3%, 242/600) and lay advocacy (36.0%, 216/600) strategies did not significantly improve participation over the control.

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Cancer

A nationwide FIT-based colorectal cancer screening program targeting adults aged 50-75 years was estimated to screen 8.7 to 9.4 million individuals at a cost of $32 to $39 per person screened, requiring an initial additional investment of $277.9 to $318.2 million annually. The program was estimated to prevent 2,900 to 3,100 deaths annually. Despite clear evidence linking colorectal cancer screening to lower incidence and mortality, over 40% of eligible adults remain not up to date with screening. The health economic evaluation demonstrated that organized screening delivery achieves substantial public health impact at moderate per-person cost.

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