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A National Bowel Cancer Screening Programme using FIT: Achievements and Challenges.

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Ireland's National Screening Service offered fecal immunochemical tests (FIT) for colorectal cancer. Adjusting the FIT threshold improved positivity rates, enabling earlier cancer detection and management within available colonoscopy resources.

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Area of Science:

  • Public Health
  • Gastroenterology
  • Oncology

Background:

  • Colorectal cancer is a significant cause of cancer mortality in Ireland.
  • Early diagnosis and detection of premalignant lesions are crucial for improving outcomes.

Purpose of the Study:

  • To evaluate the implementation and outcomes of a national fecal immunochemical test (FIT) screening program for colorectal cancer.
  • To assess the impact of adjusting FIT thresholds on positivity rates and colonoscopy capacity.

Main Methods:

  • A national screening program offered FIT to individuals aged 60-69.
  • Positive FIT results led to colonoscopy referrals.
  • The FIT threshold was adjusted from 20 μg/g to 45 μg/g to manage colonoscopy capacity.

Main Results:

  • Uptake was 40.2% (196,238/488,628).
  • Initial positivity rate (8.6% at 20 μg/g) overwhelmed capacity; adjusted threshold (45 μg/g) yielded 5% positivity.
  • 520 cancers detected (68.3% early stage), 104 endoscopically removed.
  • Adenomas found in 54.2%, high-risk in 17.4%.
  • Males had higher cancer and high-risk adenoma rates despite lower uptake.

Conclusions:

  • The FIT screening program successfully detected early-stage colorectal cancer and adenomas.
  • Adjusting FIT sensitivity is a flexible strategy to balance screening effectiveness with colonoscopy resources.
  • Addressing low uptake, particularly in males, and increasing colonoscopy capacity are key challenges.