For American Patients Interested in Screening, Colonoscopy Resulted in Higher Adherence and Detection Than Annual Fecal Testing
Douglas K. Rex, MD, MASGE, reviewing Zauber AG, et al. Gastroenterology 2023 Mar 20.
In 3 U.S. centers, asymptomatic patients aged 50 to 69 years (or 40-69 if Black) were randomized to screening colonoscopy or annual sequential high-sensitivity guaiac fecal occult blood testing (HSgFOBT). Importantly, all aspects of the trial were facilitated by coordinators. In the colonoscopy arm, 83.6% of patients completed the baseline examination. In the HSgFOBT arm, 73.1% completed the baseline test, but only 38% completed successive annual rounds.
In the screening-colonoscopy arm, any adenoma or serrated lesion was found in 22.7% of participants. Among those who were adherent to the protocol, either cancer or an advanced adenoma or advanced serrated lesion was found in 8.2% in the colonoscopy arm versus 3.3% in the HSgFOBT arm.
Among those who were never positive in the HSgFOBT arm, 30% overall crossed over to colonoscopy, including 39.8% at one center, and 5.5% of crossovers had an advanced lesion.
COMMENTStandard guaiac fecal testing is no longer recommended, but high-sensitivity guaiac testing is an option included in the recommendations from the U.S. Preventive Services Task Force. This study shows that, even with facilitators, sustaining adherence to annual fecal testing is difficult. At these U.S. centers, adherence to screening colonoscopy was very high among willing patients. Further, almost one-third of patients assigned to annual fecal testing abandoned it for colonoscopy.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Zauber AG, Winawer SJ, O’Brien MJ, et al. Randomized trial of facilitated adherence to screening-colonoscopy versus sequential fecal-based blood test. Gastroenterology 2023 Mar 20. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2023.03.206)
