Feasibility and Colonoscopy Yield Using the Fecal Immunochemical Test (FIT)-Based Colorectal Cancer Screening in a...

Area of Science:

• Gastroenterology
• Public Health
• Cancer Screening

Background:

• Organized colorectal cancer (CRC) screening is underutilized in Latin America.
• Regional studies are crucial for overcoming implementation barriers in national screening programs.
• This study describes a fecal immunochemical test (FIT)-based CRC screening program in Brazil.

Purpose of the Study:

• To describe the implementation and findings of a FIT-based CRC screening program in Brazil.
• To assess the feasibility and yield of FIT-based CRC screening in a low-resource setting.
• To provide a model for broader CRC screening dissemination in Brazil and Latin America.

Main Methods:

• A prospective, population-based study involving asymptomatic individuals aged 50-75 in Sao Paulo.
• Participants underwent FIT screening; positive results (≥10 μg Hb/g feces) led to colonoscopy referral.
• Colonoscopy compliance, Boston Bowel Preparation Scale, and cecal intubation rates were assessed.

Main Results:

• Out of 9881 participants, 7.8% had a positive FIT, with 68.9% undergoing colonoscopy.
• CRC was diagnosed in 5.9% of cases, adenoma in 63.2%, advanced adenoma in 31.4%, and advanced neoplasia in 33.0%.
• Higher FIT concentrations correlated with increased detection of CRC, advanced adenoma, and advanced neoplasia.

Conclusions:

• FIT-based CRC screening is feasible in low-resource settings like Brazil.
• The program demonstrated a high yield for detecting neoplasia, including CRC.
• This model can inform the expansion of organized CRC screening across Brazil and Latin America.