Reducing the number of surveillance colonoscopies with faecal immunochemical tests

We read with interest the article by Cross et al,1 which examined the use of FIT in intermediate risk patients undergoing 3 yearly surveillance colonoscopies. The investigators assessed the diagnostic accuracy of this approach, together with the number of advanced adenomas and colorectal cancers missed, and the potential cost savings.

The results indicate that replacing 3 yearly colonoscopy with annual FIT (with a positivity threshold of 40 µg Hb/g faeces) would result in cost savings over the screening cycle of £4.7 million reflecting an 87% reduction in colonoscopies. However, such an approach would miss up to 41% of interval cancers and 67% of advanced adenomas. Modelling a lower FIT positivity threshold (10 µg Hb/g faeces) suggests that the strategy would reduce colonoscopies by 71% but would still miss 28% of cancers and 43% of advanced adenomas. Regardless of the financial savings, such a clinical outcome is likely to be deemed unacceptable. In addition to...

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