Fecal Immunochemical Testing in Colorectal Cancer Screening
Summary
Fecal immunochemical testing (FIT) is a non-invasive screening modality that quantifies haemoglobin levels in stool to detect occult bleeding from colorectal neoplasia. By offering a simple home-based collection and precise measurement of faecal haemoglobin concentration, FIT has largely supplanted guaiac-based tests in organised screening programmes worldwide. Its superior specificity and sensitivity facilitate early detection of both advanced adenomas and carcinomas, thereby downstaging disease at diagnosis and reducing mortality. Programme administrators can adjust positivity thresholds to balance diagnostic yield against colonoscopy capacity, tailoring implementation to local resources. Moreover, FIT has been integrated into symptomatic pathways to triage patients for urgent investigation, combining quantitative results with clinical parameters in risk prediction models. Current research focuses on optimising cut-off values, minimising overdiagnosis, personalising screening intervals, and understanding extra-colonic cancer risks in FIT-positive individuals. Collectively, these advances underscore FIT’s pivotal role in global colorectal cancer control.
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Fecal Immunochemical Testing in Colorectal Cancer Screening publication trend
The graph below shows the total number of articles in fecal immunochemical testing in colorectal cancer screening across all publications each year (not limited to Nature Index journals).
Technical terms
Faecal haemoglobin concentration (f-Hb): The measured amount of haemoglobin per gram of stool, used to determine test positivity and stratify risk.
Advanced neoplasia (AN): Colorectal lesions including advanced adenomas and carcinomas characterised by high malignant potential.
Positive predictive value (PPV): The proportion of individuals with a positive test result who truly have the target condition.
Interscreening interval: The period between successive FIT screenings, which may be adjusted based on individual risk factors such as baseline f-Hb.
References
- Precision Colorectal Cancer Fecal Immunological Test Screening With Fecal-Hemoglobin-Concentration–Guided Interscreening Intervals. JAMA Oncology (2024).
- Risk of Cancers Proximal to the Colon in Fecal Immunochemical Test Positive Screenees in a Colorectal Cancer Screening Program. Gastroenterology (2024).
- Colonoscopy findings after increasing two‐stool faecal immunochemical test (FIT) cut‐off: Cross‐sectional analysis of the SCREESCO randomized trial. Journal of Internal Medicine (2024).
- The performance of FIT-based and other risk prediction models for colorectal neoplasia in symptomatic patients: a systematic review. EClinicalMedicine (2023).
- Fecal Immunochemical Tests Compared with Guaiac Fecal Occult Blood Tests for Population‐Based Colorectal Cancer Screening. Canadian Journal of Gastroenterology and Hepatology (2000).
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