The Association of FIT-Based Colorectal Cancer Screening with Earlier Disease Detection: The Romanian Experience

Background/Objectives: Given the increasing burden of colorectal cancer (CRC), effective screening strategies are essential for early disease detection. As a primary endpoint, this study aimed for the assessment and comparison of two different diagnostic pathways in the Romanian population: population-based screening using the fecal immunochemical test (FIT) and opportunistic, symptom-driven, colonoscopy. Methods: A retrospective observational study was conducted in two groups comprising a total of 236 patients from an average-risk population across Romania. Group A consisted of patients diagnosed through a CRC screening pathway based on FIT, whereas group B included patients diagnosed following opportunistic colonoscopy performed in routine clinical practice. Patients were retrospectively analyzed according to the tumor-node-metastasis (TNM) classification, with early- versus late-stage disease defined on the basis of overall TNM stage. Overall stage, tumor (T) stage and lymph node (N) stage were additionally analyzed as ordinal outcomes. Binary and ordinal logistic regression models were adjusted for tumor location. Results: The odds of detecting CRC in stage I were 2.76-fold higher in the screening group than in the opportunistic colonoscopy group. For advanced stage disease, the difference did not show statistical significance. Analyses, stratified by tumor location, identified a statistically significant association for left-sided colon and rectal tumors. The odds of detecting a T1 tumor were 6.34-fold higher in the screening group than in the opportunistic colonoscopy group. Regarding lymph node involvement, the odds of detecting N0 disease were 2.03-fold higher in Group A than in Group B. Conclusions: Compared with opportunistic diagnosis, the screening pathway was associated with a higher likelihood of detecting CRC at an earlier stage, including tumors with limited local invasion and no lymph node involvement. These findings support the potential benefit of population-based CRC screening for earlier disease detection, although they should be interpreted in the context of the observational study design.