Fecal Immunochemical Test

A recent study assessed the potential role of the fecal immunochemical test for colorectal cancer screening in at risk patients.


Colorectal cancer (CRC) develops in the colon or rectum, and it accounts for 10% of cancer-related mortality in western world1. Most colorectal cancer begins as a polyp then grow into advanced neoplasia(AN) and, ultimately, cancer. These growths in the tissue can be detected through several screening techniques, which have been proven to reduce cancer-related death. It is critical to perform regular screening since treatment options for CRC are very limited.

Available screening methods include colonoscopy, fecal occult blood tests or computed tomography colonography1, 2. These strategies are associated with high cost, low compliance, and high risk for rare, but serious, complications. Another potential method for screening is fecal immunochemical testing (FIT)3. It tests for hidden blood in stool, and it has high accuracy and compliance. However, its use for screening of individuals at high risk for CRC has not been explored.

A new study published in JAMA Internal Medicine examined the diagnostic accuracy of FIT for CRC or AN in asymptomatic individuals with familial or personal history of CRC4. The researchers extracted data from 12 studies, which included 6204 patients, and found that FIT had high diagnostic accuracy in predicting CRC in patients at above-average personal or familial risk. However, FIT had moderate diagnostic accuracy in predicting AN. Also, the diagnostic sensitivity was lower in individuals with a family history of CRC compared with a personal history.

This was the first systematic review evaluating the diagnostic accuracy of FIT in individuals at increased risk for CRC, and it showed that FIT has high overall diagnostic accuracy in this population. Further studies with randomized clinical trials are required to understand the full potential of FIT. Successful FIT implementation will ease the CRC screening process and provide an easier option for patients to choose.


Written by Boram Ham, PhD

  1. B. Levin, T. B. Ades, D. Brook, American Cancer Society., American Cancer Society’s complete guide to colorectal cancer. (American Cancer Society, Atlanta, Ga., 2006), pp. xxv, 418 p.
  2. F. Amersi, M. Agustin, C. Y. Ko, Clin Colon Rectal Surg 18, 133-140 (2005).
  3. MedlinePlus. (2017).
  4. A. Katsoula, P. Paschos, A. B. Haidich, A. Tsapas, O. Giouleme, JAMA Intern Med, (2017).
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