Stool-Based Colorectal Cancer Screening: Comparison of Fecal Immunochemical Tests

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In a Dutch study reported in The Lancet Oncology, Wisse et al found that a multitarget fecal immunochemical test (mtFIT) improved detection of advanced adenomas vs standard FIT in colorectal cancer screening. The mtFIT used in the study measures hemoglobin, calprotectin, and serpin family F member 2.

Study Details

Individuals aged 55 to 75 years eligible for the Dutch national FIT-based colorectal cancer screening program were invited to submit both a FIT and mtFIT sample collected from the same bowel movement. Positive FIT (47 μg/g hemoglobin cutoff) or mtFIT (based on decision-tree algorithm) led to colonoscopy referral. The primary outcome measure was the relative detection rate of mtFIT vs FIT for all advanced neoplasia.

Key Findings

Between March and December 2022, 35,786 individuals were invited to participate, with 15,283 (43%) consenting. Of these, 13,187 (86%) provided both mtFIT and FIT samples with valid results.

For advanced neoplasia, positivity rates were 9.11% (95% confidence interval [CI] = 8.62%–9.61%) for mtFIT vs 4.08% (95% CI = 3.75%–4.43%) for FIT, and detection rates were 2.27% (95% CI = 2.02%–2.54%) vs 1.21% (95% CI = 1.03%–1.41%), respectively. Detection rates with mtFIT vs FIT were: 0.20% (95% CI = 0.13%–0.29%) vs 0.17% (95% CI = 0.11%–0.27%) for colorectal cancer; 1.64% (95% CI = 1.43%–1.87%) vs 0.86% (95% CI = 0.72%–1.04%) for advanced adenoma; and 0.43% (95% CI = 0.33%–0.56%) vs 0.17% (95% CI = 0.11%–0.26%) for advanced serrated polyps.

Modeling showed that mtFIT-based screening could reduce colorectal cancer incidence by 21% and associated mortality by 18% compared with the current Dutch colorectal cancer screening program—at feasible costs. Further, at equal positivity rates, mtFIT improved diagnostic yield vs FIT. For example, at an equally low positivity rate, mtFIT-based screening was estimated to further decrease colorectal cancer incidence by 5% and associated mortality by 4% compared with FIT-based screening.

The investigators concluded, “The higher detection rate of mtFIT for advanced adenoma compared with FIT holds the potential to translate into additional and clinically meaningful long-term colorectal cancer incidence and associated mortality reductions in programmatic colorectal cancer screening.”

Gerret A. Meijer, MD, of the Department of Pathology, Netherlands Cancer Institute, Amsterdam, is the corresponding author for The Lancet Oncology article. 

Disclosure: The study was funded by Stand Up to Cancer, Dutch Cancer Society, Dutch Digestive Foundation, and Health~Holland. For full disclosures of the study authors, visit