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Fecal Immunochemical Test Screening and Risk of Colorectal Cancer Death.

Chyke A Doubeni1,2, Douglas A Corley3, Christopher D Jensen3

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This summary is machine-generated.

Fecal immunochemical testing (FIT) screening significantly reduces colorectal cancer (CRC) mortality, especially for left-sided tumors. This benefit extends across diverse racial and ethnic groups, supporting its use in public health strategies.

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Area of Science:

  • Oncology
  • Gastroenterology
  • Public Health
  • Preventive Medicine

Background:

  • Colorectal cancer (CRC) remains a significant health concern, with screening tests like the fecal immunochemical test (FIT) being crucial for early detection.
  • Despite widespread use, robust evidence on the effectiveness of FIT screening in reducing CRC mortality across diverse populations and cancer locations is still developing.
  • Understanding the impact of FIT on CRC-specific death rates, particularly by tumor site and demographic factors, is essential for optimizing screening programs.

Purpose of the Study:

  • To evaluate the association between FIT screening and the risk of death from colorectal cancer (CRC).
  • To determine if FIT screening effectiveness varies by tumor location (e.g., left colon vs. right colon).
  • To assess the impact of FIT screening on CRC mortality across different racial and ethnic groups.

Main Methods:

  • A nested case-control study was conducted within a large cohort of screening-eligible individuals from two integrated health systems.
  • Cases comprised individuals aged 52-85 who died from colorectal adenocarcinoma between 2011-2017, matched with controls (1:8 ratio) based on demographics and health plan duration.
  • Exposure was defined as completing one or more FIT screenings within a 5-year period prior to diagnosis; outcomes included CRC death, analyzed by tumor location and race/ethnicity.

Main Results:

  • Completing one or more FIT screenings was associated with a 33% lower risk of death from CRC (aOR, 0.67).
  • A significantly lower risk of CRC death was observed for left-sided colon and rectal cancers (aOR, 0.58), but not for right colon cancers (aOR, 0.83).
  • FIT screening demonstrated reduced CRC mortality risk across non-Hispanic Asian (aOR, 0.37), non-Hispanic Black (aOR, 0.58), and non-Hispanic White (aOR, 0.70) individuals.

Conclusions:

  • FIT screening is associated with a reduced risk of overall CRC mortality, with a more pronounced effect observed for cancers in the left colon and rectum.
  • The protective association of FIT screening against CRC death was consistent across various racial and ethnic groups, highlighting its broad applicability.
  • These findings provide strong support for the integration and continued use of FIT in population-based colorectal cancer screening strategies.