An analysis conducted in U.S. community health centers has shown that mailed FIT-DNA kits are more effective than the standard FIT test at increasing colorectal cancer (CRC) detection.
However, less than 40% of patients with abnormal results complete follow-up colonoscopy, raising concerns about care for this disease.
Colorectal cancer is the second most common cause of cancer death in the US, and disadvantaged populations are at higher risk. Although early detection can reduce incidence and mortality, screening participation remains inadequate in many communities.
The study, published in JAMA Interior Medicineshighlights the potential of the FIT-DNA method as a more perfect option and less dependent on health personnel.
The study compared two mail outreach approaches: the FIT test with an automated reminder system and the FIT-DNA test with a manufacturer contact protocol. Results showed higher screening participation rates in the FIT-DNA group, with a shorter time to testing participation.
FIT and FIT-DNA tests are non-invasive screening methods designed to identify early signs of colorectal cancer or precancerous polyps by analyzing stool samples. Both exams are typically performed at home, avoiding the need for prior preparation or sedation as with a colonoscopy.
Fecal Immunochemical Test (FIT)
The FIT test is a simple test that detects the presence of occult blood in the stool, a possible indicator of lesions or polyps in the colon. Unlike older occult blood methods, FIT is highly specific for human blood coming from the depraved digestive tract, which reduces false alarms caused by diet or medications.
- Recommended frequency: It is usually performed once a year in adults aged forty-five years or older with average risk.
- Procedure: The patient collects a stool sample using an applicator provided in the kit, places it in a tube, and sends it to the laboratory for analysis.
FIT-DNA Test
The FIT-DNA test, also known as stool DNA testing or sDNA-FIT, combines FIT technology with genetic analysis to look for specific biomarkers. This test not only looks for blood, but also identifies fragments of mutated DNA that break off from cancer cells or polyps in the lining of the colon.
- Recommended frequency: Given its methodology, experts generally suggest performing it every three years.
- Considerations: It is an examination that requires a medical prescription and consists of collecting a complete stool for sending to a specialized laboratory.
Challenges in continuity of care
Despite the increase in detection, conversion of abnormal results to colonoscopies was not optimal. Only 36 of the 100 participants with abnormal results completed colonoscopy within 180 days. Economic and social factors may contribute to this low follow-up rate, highlighting the need for more effective strategies that motivate at-risk patients.
The screening participation rate was higher in Boston than in Los Angeles, although the advantage of FIT-DNA was greater in the latter. The demographic characteristics of participants could influence these differences, underscoring the importance of personalizing community-based outreach strategies.
This study implies that although the delivery of FIT-DNA testing may improve CRC detection, barriers to continuity of care following abnormal test results still need to be addressed. Additional initiatives are suggested to encourage colonoscopy, which is essential to improve outcomes and mortality associated with colorectal cancer in vulnerable populations.
You may also be interested in:
· The microbiome: key to understanding the increase in colorectal cancer in young people
· Increase in colorectal cancer, a global alarm: early symptoms and preventive recommendations
· Colorectal cancer is the one that has caused the most deaths in people under 50 years of age
