In a computer simulation, FIT -- fecal immunochemical testing -- done every year saved more lives and cost the least of any colorectal cancer screening method, including colonoscopy.

The computer model looked at 100,000 average risk people and compared screening methods results for

• number of colorectal cancer cases
• number of colorectal cancer deaths
• cost of screening and treating colorectal cancer for each screened person

Compared to not screening at all, annual FIT could save 3 out of 4 deaths from colorectal cancer. For every 100,000 people between 50 and 75, nearly 3,500 people wouldn't get colorectal cancer, and over 1,300 wouldn't die.

Not only did FIT screening save the most lives, but it was also the most cost-effective.  It saved about $70 (Canadian) in screening and cancer treatment expenses for each person screened, better than any other method.

FIT vs Colonoscopy

Steven Heitman, of the University of Calgary in Alberta and his team found

• If no one was screened at all, there would be 4,857 cases of colon or rectal cancer and 1,782 deaths over the lifetime of every 100,000 people in North America.
• Annual testing with FIT reduced cases of colorectal cancer to 1,393 and deaths to 457.
• Colonoscopy done every ten years, with follow-up exams every 3 to 5 years when polyps were found, would reduce cases to 1,825 and deaths to 624.

While FIT was more effective than colonoscopy, it needed to be done every year, while colonoscopy screening is recommended every ten years.  The researchers  wrote,

Although it may seem counterintuitive that screening with FIT could be even more effective than colonoscopy, this is due to the more frequent screening interval with FIT.

The computer assumed that patients would adhere to a program of annual testing with follow-up colonoscopy for positive testing 63 percent of the time.  When adherence fell below 40 percent, colonoscopy became a better option.

Healthcare Costs of Screening and Cancer Treatment

In considering health care costs, the research team included the cost of screening itself, follow-up colonoscopy when required, treating bleeding or perforation complications of colonoscopy or CT colonography, and the cost of recommended surgery and chemotherapy for each stage of cancer.  They also included expenses for time and travel for patients and caregivers.  All costs were reported in 2008 Canadian dollars.

All methods included in the model were considered to be done at the recommended intervals, with appropriate follow-up.  .

Per person screened, the cost of screening and recommended cancer treatment, including biologics for stage IV cancer:

• FIT --$1,833
• No screening -- $1,901
• High sensitivity FOBT -- $2,084
• Colonoscopy -- $2,100
• Low sensitivity FOBT -- $2,192
• Flexible sigmoidoscopy -- $2,263
• CT colonography-- $2,409
• Fecal DNA test (2nd standard) -- $2,491
• Fecal DNA (first standard) -- $2,720

FIT vs Other Screening Methods

A fecal immunochemical test with mid-level sensitivity was more effective than any other screening method overall.  A higher sensitivity FIT reduced cancers and cancer deaths, but cost more.  A low sensitivity test, with only one sample, was less effective overall -- costing more and reducing fewer cases and deaths.

Method	CRC Cases	Deaths
No Screening	4,857	1,782
FIT-high	1,290	432
FIT -mid	1,383	457
CT-colonography	1,796	593
Colonoscopy	1,825	648
Flexible Sig	2,634	918
FIT-low	2,634	918
Fecal DNA (2nd)	3,129	1,143
FOBT -- low	3,457	1,250
FOBT -- high	3,890	1,368
Fecal DNA (1st)	4,131	1,530

In conclusion, Steven J. Heitman and colleagues at the University of Calgary in Alberta wrote,

CRC screening with FIT reduces the risk of CRC and CRC-related deaths and lowers health care costs in comparison to no screening and to other existing screening strategies. Health policy decision-makers should consider prioritizing funding for CRC screening using FIT.

Although FIT proved the best at preventing new cancers and cancer deaths, all the screening methods studied were better than no screening at all.

Colorectal cancer screening saves lives!

The American Cancer Society has an excellent review of the current screening guidelines with detailed descriptions of each of the screening methods that were modeled.

SOURCE:  Heitman et al., PLoS Medicine, November 23, 2010.  An Open Access article from the Public Library of Medicine.

What Does This Mean for Patients?

This study offers more information about effective ways of screening for colorectal cancer.

Although you may have considered colonoscopy the "gold standard",  this research demonstrates that for a large group of people, annual FIT testing actually prevents more cases of cancer and saves more lives.

If the risks of colonoscopy screening concern you, choosing FIT might be a choice for you.  If you do you need to be sure:

• You are willing to do the test every year.
• You realize that a positive test needs colonoscopy follow-up and you are willing to do that.
• Your doctor explains the sensitivity of the different FIT tests and you are given one that has mid to high level sensitivity.
• You get clear instructions for completing the test at home and mailing it back.
• You are an average risk person with no family or personal risks for colorectal cancer.

FIT might also be an affordable choice for people without insurance -- although if positive, colonoscopy is necessary.

FIT is a different fecal test than the more commonly used FOBT -- fecal occult blood test.  In the computer model, FOBT screening prevented the fewest cancers and saved the fewest lives except for the earlier version of fecal DNA testing.  Be sure that the test you are getting is a fecal immunochemical test.

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