Colon Cancer Screening: Stool Biomarker May Be Equivalent To Colonoscopy

Enrique Quintero MD, PhD President, Asociación Española de Gastroenterología (AEG) Chief of Gastroenterology, Hospital Universitario de Canarias Professor of Medicine, Universidad de La Laguna La Laguna. Tenerife SpainMedicalResearch.com Interview with:
Enrique Quintero MD, PhD
President, Asociación Española de Gastroenterología (AEG)
Chief of Gastroenterology, Hospital Universitario de Canarias
Professor of Medicine, Universidad de La Laguna
La Laguna. Tenerife Spain

Medical Research: What is the background for this study? What are the main findings?

Dr. Quintero: First degree relatives (FDRs) of patients with colorectal cancer (CRC) are at increased risk of developing the disease compared with the general population. For that reason, clinical practice guidelines recommend colonoscopy every five years starting at the age of 40 years or ten years less than the youngest case in the family. However, this approach has some drawbacks:

  • first, several studies have shown that the benefit of colonoscopy is limited by a low uptake (less than 40%);
  • second, it represents an important colonoscopy burden, as about 70-80% of explorations are normal or without relevant lesions, which implies a high resource consumption; and
  • third, this recommendation is not based on evidence, as no randomized controlled trials have compared the efficacy of screening colonoscopy with that of other strategies.On the other hand, pilot studies have shown that one-time fecal immunochemical tests (FIT) have acceptable capacity to detect advanced neoplasia (defined as cancer or advanced adenoma) in family members of patients with CRC. For these reasons we conducted a prospective randomized trial to compare the efficacy of repeated fecal immunochemical tests versus one-time colonoscopy for detecting advanced colorectal neoplasia in asymptomatic FDRs of patients with colorectal cancer.

The main finding of our study was that cumulative fecal immunochemical tests screening (1 per year, during 3 years), yielded an equivalent detection rate to one-time colonoscopy for cancer, advanced adenoma and advanced neoplasia both by intention-to-screen and per-protocol analysis, after controlling for confounders such as age, gender, index-case age, and number of affected relatives. In fact, FIT detected all cancers and 61% of advanced adenomas. In addition, the study confirmed that the number of subjects requiring colonoscopy to detect one advanced neoplasm was 4 times less in individuals screened by FIT than in those screened by colonoscopy. Therefore, FIT may save a substantial number of unnecessary colonoscopies, preventing harms and lowering costs.

Medical Research: What should clinicians and patients take away from your report?

Dr. Quintero: Our study demonstrate that annual FIT screening is as effective as colonoscopy for detecting colorectal cancer or advanced adenoma in the familial risk population, which may safe colonoscopy resources in this population. For that reason, FIT screening should be considered a valid alternative when colonoscopy capacity is limited and in populations where FIT is better accepted than colonoscopy as a screening strategy.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Quintero: The use of FIT screening as an alternative to colonoscopy in the familial risk population will finally depend on its capacity to improve screening uptake. Therefore, additional studies are needed to determine acceptance of this strategy and its efficacy in reducing the incidence and mortality associated with familial colorectal cancer.

Citation:

Equivalency of Fecal Immunochemical Tests and Colonoscopy in Familial Colorectal Cancer Screening

Quintero E, Carrillo M, Gimeno-García AZ2Hernández-Guerra M, Nicolás-Pérez D, Alonso-Abreu I, Díez-Fuentes ML, Abraira V
Gastroenterology. 2014 Aug 13. pii: S0016-5085(14)01000-2. doi: 10.1053/j.gastro.2014.08.004. [Epub ahead of print]