Simple, At-Home Test Will Detect About 79 Percent of
Largest and most comprehensive review of ‘FIT’ finds
it is an effective cancer-screening tool - see video
Feb. 4, 2014 – Seniors who frequently dread
colonoscopies will be delighted by a new study that finds tests that
require patients to collect a single stool sample at home and then send
it to a lab for analysis will detect about 79 percent of colorectal
cancers. The review of 19 studies examining eight different fecal
immunochemical tests, known as “FITs,”
also finds that the tests will correctly identify about 94 percent of
patients who do not have cancers of the rectum or colon.
Colorectal cancer is the second leading cause of
cancer death in the United States, according to the Centers for Disease
Control and Prevention. Yet one in three adults is not adequately
“FIT is simple, can be done at home, and can save
lives,” said Jeffrey Lee, MD, MAS, the study’s lead author and
post-doctoral researcher at the
Division of Research in Oakland, Calif. and University of
California, San Francisco.
“The American Cancer Society and other professional
organizations have recommended FIT as a screening tool for colorectal
cancer since 2008, but there are still many people who don’t know about
The U.S. Preventive Services Task Force recommends
that people with normal risk for colorectal cancer should begin
screening at age 50 and stop at age 75.
Unlike older stool tests, FIT does not require
people to restrict their diets or to stop taking medications. Conducted
annually, the test detects small amounts of blood in the stool, and
people who test positive are much more likely to have colorectal cancer.
People who have a positive FIT need a follow-up colonoscopy to look for
cancer or pre-cancerous polyps.
Other screening options for colorectal cancer
include sigmoidoscopy, which involves physical examination of the lower
colon, recommended every five years; or colonoscopy, which examines the
entire colon, every 10 years.
The evidence review, funded by the National
Institutes of Health, found that the FITs were fairly sensitive. On
average, the tests detected 79 percent, or about 4 of 5 cancers with
only one round of testing. The tests were also highly specific: on
average, 94 percent of people who did not have cancer tested negative
with a single FIT.
By comparison, studies indicate that another
at-home test called fecal occult blood test (also known as FOBT) detects
only about 13 percent to 50 percent of cancers after a single round of
testing. The FOBT is the predecessor to FIT and requires three stool
samples as well as medication and dietary restrictions.
According to the evidence review, no single FIT
performed markedly better than another, but the authors caution that
there was only one study comparing brands head-to-head. Most of the FITs
required collection of only one stool sample. Surprisingly, the authors
found that brands requiring two or three stool samples were no more
accurate than those requiring only one sample.
The 19 studies reviewed included between 80 and
27,860 patients, with the average age ranging from 45 to 63. Study
settings varied, but all included patients with no symptoms of
colorectal cancer. In 12 of the studies, all patients took the FIT and
received a colonoscopy. In seven studies, patients only had a
colonoscopy to follow-up on a positive FIT. Approximately two years
later, researchers followed up with patients who had had a negative FIT
to determine whether they had been diagnosed with colorectal cancer.
This research is part of Kaiser Permanente’s
ongoing efforts to promote prevention and evidence-based care. Last year
Kaiser Permanente researchers found that patients who visited their
doctor for any reason were nearly
six times more likely
to get screened for colon cancer compared to those who didn’t
visit their doctor.
The review was supported by grants from the
National Institute of Diabetes and Digestive and Kidney Diseases, the
National Cancer Institute, and the NCI consortium Population-Based
Research Optimizing Screening through Personalized Regimens
(T32DK007007, U24 CA171524 and U54 CA163262).
Authors include: Jeffrey K. Lee, MD, MAS, Kaiser
Permanente Division of Research, Oakland, Calif. and University of
California, San Francisco; Elizabeth G. Liles, MD, MCR, Kaiser
Permanente Center for Health Research, Portland, Ore.;
Stephen Bent, MD,
University of California, San Francisco; and
Theodore Levin, MD,
Douglas A. Corley, MD,
PhD, Kaiser Permanente Division of Research, Oakland, Calif.
About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and
disseminates epidemiologic and health services research to improve the
health and medical care of Kaiser Permanente members and society at
large. It seeks to understand the determinants of illness and
well-being, and to improve the quality and cost-effectiveness of health
care. Currently, DOR’s 550-plus staff is working on more than 250
epidemiological and health services research projects. For more
or follow us on Twitter
About the Kaiser Permanente Center for Health
The Kaiser Permanente Center for Health Research, founded in 1964, is a
nonprofit research institution dedicated to advancing knowledge to
improve health. It has research sites in Portland, Ore., Honolulu and
About Kaiser Permanente
Kaiser Permanente reports it is recognized as one of America’s leading
health care providers and not-for-profit health plans. Founded in 1945,
its mission is to provide high-quality, affordable health care services
and to improve the health of members and the communities it serves. It
currently serve 9.1 million members in eight states and the District of
Columbia. For more information, go to: kp.org/share.
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