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Divergent Long-Term Detection Rates of Proximal and Distal Advanced Neoplasia in Fecal Immunochemical Test Screening

Manuel Zorzi1, Cesare Hassan2, Giulia Capodaglio3

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The fecal immunochemical test (FIT) shows limited long-term effectiveness in detecting proximal colorectal neoplasia, with higher interval cancer rates in this region. This highlights challenges in preventing age-related proximal colorectal cancer shifts with repeated FIT screening.

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Area of Science:

  • Gastroenterology
  • Oncology
  • Public Health

Background:

  • Short-term studies suggest fecal immunochemical test (FIT) accuracy varies by colorectal lesion location.
  • Proximal colorectal neoplasia detection is reportedly less sensitive with FIT compared to distal lesions.

Purpose of the Study:

  • To evaluate long-term colorectal cancer (CRC) and advanced adenoma detection rates using FIT.
  • To analyze detection rates based on anatomical location (proximal colon, distal colon, rectum) over multiple screening rounds.

Main Methods:

  • Retrospective analysis of a population-based FIT screening program in Italy (2002-2014).
  • Inclusion of participants aged 50-69 years undergoing six rounds of FIT screening.
  • Calculation of detection rates for advanced adenoma and CRC, and proportional interval cancer rate (PICR) by anatomical site.

Main Results:

  • FIT showed a negligible reduction in proximal neoplastic lesion detection rates after the first round.
  • Detection rates for distal colon and rectal cancer and advanced adenoma steadily decreased over six rounds.
  • The proximal colon exhibited a significantly higher proportional interval cancer rate (25.2%) compared to the distal colon (6.0%) and rectum (9.9%).

Conclusions:

  • Long-term FIT screening demonstrated limited efficacy in reducing proximal neoplastic lesion detection rates.
  • Higher PICR in the proximal colon suggests suboptimal performance in this region.
  • The study indicates challenges in preventing age-related proximal shifting of CRC with repeated FIT screening.