Related Experiment Video
Updated: Jun 5, 2026
Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
Published on: June 8, 2020
Diagnostic yield improves with collection of 2 samples in fecal immunochemical test screening without affecting
Aafke H C van Roon1, Janneke A Wilschut, Lieke Hol
1Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands. a.vanroon@erasmusmc.nl
Insights
One or two fecal immunochemical tests (FIT) yield similar attendance rates for colorectal cancer screening. Two FIT samples increase positive test outcomes, aiding efficient screening strategies.
Area of Science:
- Gastroenterology
- Oncology
- Preventive Medicine
Background:
- Fecal immunochemical test (FIT) is a preferred method over guaiac-based tests for neoplasia detection.
- Optimal number of FIT samples for screening effectiveness requires further investigation.
Purpose of the Study:
- To compare attendance and diagnostic yield of 1-sample versus 2-sample FIT screening.
- To inform the development of efficient FIT screening strategies.
Main Methods:
- Population-based trial involving two randomly selected groups (1-sample FIT, n=5007; 2-sample FIT, n=3197) aged 50-74.
- Subjects in the 2-sample group collected samples on consecutive days.
- Referral for colonoscopy was based on positive FIT results (≥50 ng hemoglobin/mL).
Main Results:
- Attendance rates were comparable between 1-sample (61.5%) and 2-sample (61.3%) FIT groups.
- The 2-sample FIT strategy resulted in a higher proportion of positive test outcomes (12.8%) compared to 1-sample FIT (8.1%).
- Detection rates for advanced neoplasia were similar across strategies, with a trend towards higher detection with 2-sample FIT.
Conclusions:
- No significant difference in attendance between 1- and 2-sample FIT screening.
- Two-sample FIT screening offers potential for enhanced detection strategies adaptable to colonoscopy capacity.
- Findings support flexible FIT screening protocols beyond solely adjusting cutoff values.
Background & Aims:
The fecal immunochemical test (FIT) is superior to the guaiac-based fecal occult blood test in detecting neoplasia. There are not much data on the optimal number of FITs to perform. We conducted a population-based trial to determine attendance and diagnostic yield of 1- and 2-sample FIT screening.
Methods:
The study included 2 randomly selected groups of subjects aged 50-74 years (1-sample FIT, n=5007; 2-sample FIT, n=3197). The 2-sample group was instructed to collect fecal samples on 2 consecutive days. Subjects were referred for colonoscopy when at least 1 sample tested positive (≥50 ng hemoglobin/mL).
Results:
Attendance was 61.5% in the 1-sample group (2979 of 4845; 95% confidence interval, 60.1%-62.9%) and 61.3% in the 2-sample group (1875 of 3061; 95% confidence interval, 59.6%-63.0%; P=.84). In the 1-sample group 8.1% tested positive, and in the 2-sample group 12.8% had at least 1 positive test outcome and 5.0% had 2 positive test outcomes (P<.05). When the mean from both test results in the 2-sample group was used, 10.1% had a positive test outcome (P<.05). The detection rates for advanced neoplasia were 3.1% in the 1-sample group, 4.1% in the 2-sample group with at least 1 positive test outcome, 2.5% when both test results were positive, and 3.7% among subjects with the mean from both test results being positive.
Conclusions:
There is no difference in attendance for subjects offered 1- or 2-sample FIT screening. The results allow for the development of efficient FIT screening strategies that can be adapted for local colonoscopy capacities, rather than varying the cut-off value in a 1-sample strategy.
