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Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
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Is Negative Fecal Immunochemical Test Reassuring? The Cumulative Risk of Colorectal Cancer after Multiple Negative

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A negative fecal immunochemical test (FIT) result does not eliminate colorectal cancer (CRC) risk, as two-thirds of the 10-year risk persists. Continued biennial FIT screening is crucial for monitoring CRC risk and reducing mortality.

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Area of Science:

  • Gastroenterology
  • Oncology
  • Preventive Medicine

Background:

  • Colorectal cancer (CRC) has a baseline risk of approximately 0.1%.
  • Fecal immunochemical tests (FITs) are used for CRC screening, identifying about 5% of individuals as positive.
  • The reassurance value of a negative FIT result for subsequent CRC risk is not fully established.

Purpose of the Study:

  • To evaluate the long-term colorectal cancer (CRC) risk following a negative fecal immunochemical test (FIT).
  • To assess the impact of repeated negative FIT results on CRC incidence and all-cause mortality.
  • To determine the necessity of continued biennial screening after initial negative FIT results.

Main Methods:

  • Retrospective cohort study of 141,982 Taiwanese individuals aged ≥50 undergoing screening (1994-2008).
  • CRC cases and deaths identified via National Cancer Registry and National Death File.
  • Negative FIT defined as <20 μg Hb/g; repeated biennial screening analyzed.

Main Results:

  • One negative FIT reduced CRC incidence by 63% (1.27 to 0.80/1,000 person-years).
  • Two-thirds of the 10-year CRC risk remained after one negative FIT; risk reemerged after 2 years.
  • Repeated negative FITs and consistently negative results significantly lowered CRC risk and all-cause mortality.
  • 84% of the cohort had consistently negative FIT results across five screening rounds.

Conclusions:

  • A single negative FIT result is not sufficient to rule out long-term CRC risk.
  • Continued biennial FIT screening is essential, as CRC risk reappears approximately 2 years after a negative test.
  • Consistently negative FIT results are associated with significantly reduced CRC risk and improved survival outcomes.