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Updated: Jul 11, 2025
Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
Published on: June 8, 2020
Unsatisfactory Fecal Immunochemical Tests for Colorectal Cancer Screening: Prevalence, Reasons, and Subsequent
Po-Hong Liu1, Rasmi G Nair2, Celette Sugg Skinner2,3
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
One in ten individuals had an unsatisfactory fecal immunochemical test (FIT), often due to patient-related issues like specimen collection. Less than half completed a follow-up test, highlighting a gap in colorectal cancer screening effectiveness.
Area of Science:
- Gastroenterology
- Public Health
- Health Services Research
Background:
- Fecal immunochemical test (FIT) is a key colorectal cancer screening tool.
- Understanding issues with FIT processing, like specimen problems, is crucial for screening program success.
Purpose of the Study:
- To determine the prevalence and reasons for unsatisfactory FIT results.
- To identify factors associated with unsatisfactory FIT and subsequent testing.
- To assess testing completion rates after an initial unsatisfactory FIT.
Main Methods:
- Retrospective cohort study of average-risk individuals aged 50-74 years.
- Analysis of FIT completion data from 2010-2019 within a large health system.
- Multivariable logistic regression to identify factors associated with unsatisfactory FIT and follow-up testing.
Main Results:
- 10.2% of FITs were unsatisfactory, primarily due to inadequate specimen (51%) or labeling (27%).
- Unsatisfactory FIT was linked to male sex, Black race, Spanish speaking, Medicaid insurance, and mail-based FIT delivery.
- Only 41% of individuals with an unsatisfactory FIT completed a subsequent test within 15 months.
Conclusions:
- A significant proportion of FITs are unsatisfactory, often due to patient-related factors.
- Low follow-up testing rates after an unsatisfactory FIT indicate a need for intervention.
- Addressing specimen collection and labeling issues can improve colorectal cancer screening effectiveness.
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