Why is it important to increase colon cancer screening rates?

Increased screening has resulted in a significant reduction in the incidence and mortality of colon cancer in Kentucky. Between 2001 and 2011 the Kentucky Cancer registry reports a reduction of 24% in incidence and 23% in mortality.

However there is still a large number of people who are not being screened. The Centers for Prevention and Disease Control reported that more than one-third of Americans age 50-75 were not up to date with colon cancer screening and nearly 28% had never been screened. (CDC, 2012 BRFSS) Colon cancer continues to be the second leading cause of cancer deaths for men and women combined in Kentucky. Over 800 people die each year in Kentucky from a cancer, which is largely preventable with regular screening. Link to the Colon Cancer Update

Research on Fecal Immunochemical Tests (FIT)

An increasing number of states and other countries are using a combined screening strategy of annual Fecal Immunochemical Tests for average risk people age 50 and older (age 45 if African American) and Colonoscopy for people who are at higher risk or test positive with FIT. Research has shown:

  • FIT detects 79% of colon tumors in average risk asymptomatic adults and is effective in ruling out cancer.
  • FIT has an 81% sensitivity for detecting colon cancer and 29% sensitivity in detecting advanced adenomas in average risks adults.
  • Patients were more likely to agree to be screened with FIT compared to colonoscopies, which may provide an option for patients cannot or will not agree to a colonoscopy.

Lee JK, Liles EG, Bent S, Levin TR, Corley DA, Accuracy of Fecal Immunochemical Tests for Colorectal Cancer, Annals of Internal Medicine, 2014: 160; 171-181.

In a review of 19 studies that looked at the diagnostic accuracy of FITs for colorectal cancer in asymptomatic, average-risk adults, researchers found that FITs detected 79% of colon tumors and were effective at ruling out cancer.

Quintero E, Castells A, Bujanda L, Salas D., et. al. Colonoscopy versus Fecal Immunochemical Testing in Colorectal-Cancer Screening, N Eng J Med, 2012;366:697-706.

A randomized controlled study compared Fecal Immunological Testing to Colonoscopies . After the first round of testing, colorectal cancer was found in 30 people receiving colonoscopies compared to 33 people receiving FIT testing. The study also found that people were more likely to agree to be screened using a FIT compared to a colonoscopy.

Allison JE, Sadoka LC, Leven TR, Tucker JP, Tekawa IS, Cuff T, Pauley MP, Shalager L, Palitz AM, Zhao WK, Schwartz JS, Ransohoff DF, Selby JV, Screening for Colorectal Neoplasms with New Fecal Occult Blood Tests: Update on Performance Characteristics, J Natl Cancer Inst 2007;99:1462-70.

A two-year research project looked at the effectiveness of FIT testing in three Northern California Kaiser Permanente Medical Centers. The results reported FIT had an 81% sensitivity for detection of colorectal cancer and 29% sensitivity for detecting advanced colorectal adenomas in average risk adults 50 and older with no personal or family history of colon cancer.