Systematic Review of Participation, Positivity, and Yield Over Time in Fecal Immunochemical Test-Based Organized...

Area of Science:

• Gastroenterology
• Public Health
• Preventive Medicine

Background:

• Fecal immunochemical testing (FIT) is a primary colorectal cancer (CRC) screening method globally.
• Long-term programmatic participation is crucial for FIT's effectiveness.
• Understanding adherence and yield over time is essential for optimizing screening programs.

Purpose of the Study:

• To systematically review and meta-analyze adherence patterns in organized FIT-based CRC screening programs.
• To evaluate per-round participation, FIT positivity, and neoplasia detection rates.
• To compare initial versus subsequent screening rounds.

Main Methods:

• Systematic literature search of PubMed, Embase, and Cochrane databases.
• Categorization of adherence into consistent, intermittent, and non-participants.
• Determination of per-round participation, FIT positivity, and positive predictive values (PPVs) for CRC, advanced adenoma (AA), and adenoma.

Main Results:

• 24 studies included, revealing 47.1% consistent screeners, 22.7% intermittent, and 30.3% non-participants.
• Per-round participation ranged from 51.3% to 56.7% across the first four rounds.
• FIT-positivity and PPVs for CRC, AA, and adenoma were highest in the first round and decreased in subsequent rounds.

Conclusions:

• Organized FIT screening achieves consistent participation in approximately half of individuals.
• About one-third of individuals do not participate in FIT screening programs.
• Detection rates for CRC, advanced adenoma, and adenoma are highest in the initial round and may stabilize by the third to fourth round.