Fecal Immunochemical Testing for Colorectal Cancer Screening Outside High-income Countries: A Systematic Review and...

Area of Science:

• Oncology
• Gastroenterology
• Public Health

Background:

• Colorectal cancer (CRC) incidence is increasing in low- and middle-income countries (LMICs).
• Optimal CRC screening strategies for resource-limited settings are not well-defined.
• Fecal immunochemical testing (FIT) is a cost-effective screening tool for population-based CRC detection.

Purpose of the Study:

• To systematically review and meta-analyze the diagnostic performance of FIT for CRC screening in individuals outside high-income countries (HICs).
• To assess FIT's sensitivity and specificity in detecting CRC among average-risk populations in LMICs.

Main Methods:

• A systematic literature search was conducted for studies performed in LMICs (World Bank definition).
• Eligible studies assessed FIT for CRC diagnosis in asymptomatic, average-risk individuals.
• Bivariate Bayesian meta-analysis (MetaBayesDTA) was used to calculate pooled FIT sensitivity and specificity.

Main Results:

• Seven studies published between 2015-2022, involving 100,619 participants from Argentina, Brazil, China, Iran, and Thailand, met the inclusion criteria.
• FIT return rates ranged from 78% to 99%, with positivity rates from 2.1% to 29%.
• Pooled estimates for FIT sensitivity and specificity for CRC detection were 75% (95% CI: 64%-85%) and 89% (95% CI: 77%-95%), respectively.

Conclusions:

• FIT-based CRC screening demonstrates potential in LMICs.
• Geographical data for FIT performance is currently limited to middle-income countries.
• Further research is essential to evaluate screening modalities and the complete screening continuum within LMICs.