Multiple randomized controlled trials comparing colonoscopy with the fecal immunochemical test (FIT) are currently in progress around the world. The Lancet recently published online the Effect of invitation to colonoscopy versus fecal immunochemical test screening on colorectal cancer mortality (COLONPREV) study conducted in Spain.

Performed in 15 tertiary centers, this study is the first report to compare the impact of a population-based invitation to screening with biennial FIT vs. colonoscopy on colorectal cancer (CRC) mortality. Involving 57,404 individuals, results indicate that where there is very little penetration of screening colonoscopy, more individuals participate in CRC screening after an invitation to FIT than after an invitation to colonoscopy. Because of this higher adherence with FIT, the intention-to-screen analysis found that FIT was non-inferior (i.e., similar) to colonoscopy with respect to CRC incidence and mortality. FIT has already been determined to be the best approach to programmatic CRC screening in many parts of the world, and this study lends support to that decision.

Other very important results of the study, which were unfortunately buried in the appendix, are the per-protocol analyses describing the outcomes in those who actually underwent colonoscopy compared to those who underwent FIT.  These analyses showed an 83% reduction in CRC mortality and a 33% reduction in CRC incidence in patients who underwent colonoscopy compared with those who underwent at least one FIT, indicating colonoscopy is more effective than FIT.

This research supports ASGE’s recommendation that screening colonoscopy should continue to be offered in countries where it is widely available, either as one of multiple options or as a first-line option in a sequential offer of colonoscopy first, followed by fecal tests for those who decline colonoscopy.

In the U.S., patients can usually choose which screening test to complete. When patients have a choice, they often want to know which test is most effective, and numerous studies over the years have shown that the optimal CRC screening test is colonoscopy.

For more information colonoscopy and resources for patients, please visit: ValueOfColonoscopy.org