Fecal Immunochemical Testing for Colorectal Cancer Prevention in Two Public Hospitals

The fecal immunochemical test (FIT) is highly effective in reducing colorectal cancer (CRC) mortality, but patient adherence to the screening process remains questionable. We present preliminary findings from a quality improvement (QI) initiative, in order to assess screening adherence and findings.

All FIT specimens in a 30-month period were retrospectively examined. Patients with positive results were included, and information was collected via electronic medical record, including QI measures such as colonoscopy completion and findings. All data were de-identified. Patients were divided into "asymptomatic group" and "symptomatic group" based on clinical manifestations. Adherence and findings were analyzed.

FIT results were positive in 174 out of 2400 specimens. Colonoscopy was performed in 47.6% of all FIT-positive cases after a median interval of 5.5 (interquartile range, IQR 3-10) months, with 10% having CRC, 51.3% having adenomas, and 17.5% having advanced adenomas. Of all nine patients who had CRC, seven were in the symptomatic group. All five advanced cancers were found in the symptomatic group. Patients who actually completed colonoscopy were significantly younger than those who did not (median 61.5 years, IQR 56.5-69 years, vs. 64.5 years, IQR 59-71 years, P = 0.048). Patient-related reasons, primarily refusal, accounted for 65.9% of unperformed colonoscopies. No significant difference was found in adherence and yield between asymptomatic and symptomatic groups.

Prevalence of colorectal adenomas and cancers is high in FIT-positive patients. A substantial number of CRCs and potentially preventable CRCs must have been missed because of low adherence rate, especially in older patients. Improving adherence to CRC screening in public hospitals requires enhanced patient engagement.