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Updated: Sep 10, 2025
Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
Published on: June 8, 2020
First-Round Fecal Immunochemical Test Concentration Predicts Colorectal Cancer and Advanced Neoplasia in Second-Round
Masau Sekiguchi1,2, Marcus Westerberg3, Christian Löwbeer4,5,6
1Endoscopy Division/Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
Introduction:
Enhancing fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening requires identifying additional predictive factors for colorectal neoplasia beyond current-round FIT concentration. We investigated whether first-round FIT concentration could predict colorectal neoplasia detection in the second screening round, using data from the randomized controlled trial Screening of Swedish Colons.
Methods:
We conducted a cross-sectional analysis of Screening of Swedish Colons FIT-arm participants with negative 2-stool FIT (<10 μg Hb/g feces) in the first screening round, followed by a positive FIT (≥10 μg Hb/g feces) in the second round 2 years later with workup colonoscopy. We used binary regression models to assess risk factors for colorectal neoplasia, including CRC and advanced colorectal neoplasia (ACN), at colonoscopy, according to participants' characteristics and first-round and second-round FIT concentrations.
Results:
In total, 1,991 individuals were included, with median FIT concentrations of 2.2 and 21.8 μg Hb/g feces in the first and second rounds, respectively. Higher first-round FIT concentration was associated with increased risks of CRC and ACN in the second round. Compared with those with first-round FIT concentrations of 0.0-1.9 μg Hb/g feces, the risk ratios for ACN were 1.38 (95% confidence interval 1.07-1.80) for 2.0-5.9 and 1.85 (95% confidence interval 1.38-2.48) for 6.0-9.9 μg Hb/g feces. For fixed second-round FIT concentration, the absolute risk of ACN increased in accordance with higher first-round FIT concentration.
Discussion:
Even an increase in low levels of FIT concentration is associated with future CRC and ACN detection. Combining first-round and second-round FIT results could enhance the efficacy of screening.
