In a Spanish study (COLONPREV) reported in The Lancet, Castells et al found that invitation to fecal immunochemical test (FIT) vs colonoscopy screening for colorectal cancer was associated with noninferiority in colorectal cancer mortality.
Study Details
In the multicenter study, eligible individuals from across Spain were randomly assigned to invitation to one-time colonoscopy screening (n = 26,332 in intention-to-screen group) or biennial FIT screening (n = 26,719 in intention-to-screen group). Eligible participants were from the average-risk population aged 50 to 69 with no personal or family history of colorectal cancer. The primary endpoint was colorectal cancer mortality at 10 years in the intention-to-screen population; noninferiority was defined as an absolute difference of less than 0.16 percentage points.
Key Findings
In the intention-to-screen population, participation in any form of screening was observed for 31.8% of the colonoscopy group vs 39.9% of the FIT group (risk ratio [RR] = 0.79, 95% confidence interval [CI] = 0.77–0.82). In the intention-to-screen population, the FIT group showed noninferiority to the colonoscopy group in colorectal cancer mortality risk. At 10 years, risk was 0.22% (55 deaths) in the colonoscopy group vs 0.24% (60 deaths) in the FIT group (risk difference = –0.02, 95% CI = –0.10 to 0.06; RR = 0.92, 95% CI = 0.64–1.32, P = .0005 for noninferiority).
The investigators concluded: “Participation in screening was higher among individuals invited to faecal immunochemical test screening than colonoscopy screening. On the basis of participation observed in this study, a faecal immunochemical test-based programme was noninferior to a colonoscopy-based programme for colorectal cancer–related mortality.”
Antoni Castells, MD, of the Hospital Clinic of Barcelona, University of Barcelona, is the corresponding author of The Lancet article.
Disclosure: The study was funded by Fundacion Cientifica de la Asociacion Espanola contra el Cancer and Instituto de Salud Carlos III. For full disclosures of the study authors, visit thelancet.com.
