Fecal Immunochemical Test (FIT) in Brazil: Why Brazil Changed Its Colorectal Cancer Screening Strategy in 2026

On May 21, 2026, the Brazilian Ministry of Health incorporated the fecal immunochemical test (FIT) into the national colorectal cancer screening program within the Brazilian Unified Health System (Sistema Único de Saúde – SUS). FIT became the recommended primary screening test for asymptomatic adults aged 50 to 75 years, while colonoscopy became the diagnostic examination for individuals with a positive FIT result. The policy established Brazil’s first organized, population-based colorectal cancer screening strategy designed to expand access to prevention while optimizing healthcare resources across the country.

Before 2026, colorectal cancer screening in Brazil was largely opportunistic rather than organized. Screening depended on physician recommendations, individual patient awareness, and access to healthcare services, resulting in substantial regional variation in screening uptake. Colonoscopy was the examination most commonly recommended for average-risk individuals, but no nationwide population-based screening program existed within SUS. The new policy represents a paradigm shift by introducing an organized screening pathway based on annual Fecal Immunochemical Test, with colonoscopy reserved for individuals with positive results.

The implementation of this program reflects the growing burden of colorectal cancer in Brazil. According to estimates from the Brazilian National Cancer Institute (INCA), approximately 45,630 new colorectal cancer cases are expected annually, making colorectal cancer one of the three most common malignancies in the country. It is also among the leading causes of cancer-related mortality, accounting for more than 20,000 deaths each year. These figures highlight the need for effective strategies capable of increasing early detection and reducing colorectal cancer mortality.

Population-based colorectal cancer screening requires strategies that combine clinical effectiveness, broad accessibility, and efficient allocation of healthcare resources. Brazil is the fifth-largest country in the world, with marked regional differences in healthcare infrastructure, unequal distribution of endoscopy services, and limited colonoscopy capacity within the public healthcare system. Offering primary colonoscopy to every eligible individual is therefore difficult to implement on a national scale.

The fecal immunochemical test (FIT) addresses many of these challenges by serving as an accessible first-line screening tool. FIT detects human hemoglobin in stool using specific antibodies, making it highly sensitive for bleeding from the lower gastrointestinal tract. Unlike guaiac-based fecal occult blood tests, FIT requires no dietary restrictions, bowel preparation, sedation, or specialized facilities. The examination can be distributed through primary healthcare centers throughout the country and completed at home, making it particularly suitable for organized, nationwide screening programs.

The Brazilian screening strategy follows a two-step approach. Eligible individuals first undergo Fecal Immunochemical Test, and only those with a positive result are referred for diagnostic colonoscopy. This pathway concentrates endoscopic resources on individuals with the highest probability of advanced adenomas or colorectal cancer while avoiding unnecessary colonoscopies among people with negative screening tests.

This strategy also increases the efficiency of the public healthcare system. Colonoscopy remains the diagnostic and therapeutic gold standard because it allows direct visualization of the colonic mucosa, biopsy of suspicious lesions, and removal of precancerous polyps during the same procedure. However, colonoscopy requires specialized professionals, dedicated infrastructure, bowel preparation, sedation in many patients, and substantially greater financial investment. Reserving colonoscopy for FIT-positive individuals improves resource utilization without compromising the effectiveness of organized colorectal cancer screening.

Patient participation represents another important advantage of FIT-based screening. Colonoscopy continues to be associated with procedural anxiety, bowel preparation, perceived discomfort, embarrassment, and limited appointment availability, all of which reduce adherence among asymptomatic individuals. FIT is noninvasive, home-based, inexpensive, and easier to complete, resulting in consistently higher participation rates in organized screening programs worldwide.

The expected impact of Brazil’s national FIT-based screening program extends beyond increasing participation. Organized screening is expected to improve the early detection of colorectal cancer, increase the identification and removal of advanced adenomas before malignant transformation, and shift diagnoses toward earlier disease stages, when curative treatment is more likely. Expanding screening coverage has the potential to reduce colorectal cancer mortality through earlier detection and may also reduce colorectal cancer incidence by facilitating the detection and removal of advanced adenomas during follow-up colonoscopy.

Several countries have already adopted Fecal Immunochemical Test as the primary screening modality for organized colorectal cancer screening, including the United Kingdom, the Netherlands, Australia, Canada, Italy, Spain, and France. These national programs consistently use FIT as the initial screening examination while reserving colonoscopy for individuals with positive results. Randomized trials and long-term population-based screening programs have demonstrated that this strategy increases screening participation, detects more advanced adenomas and early-stage colorectal cancers, and contributes to reductions in colorectal cancer mortality.

Successful implementation of the Brazilian program will depend on maintaining adequate diagnostic capacity following a positive Fecal Immunochemical Test result. International colorectal cancer screening guidelines emphasize that the effectiveness of FIT-based screening relies on timely access to high-quality colonoscopy after a positive test. Ensuring sufficient endoscopic capacity, particularly in underserved regions with limited healthcare infrastructure, remains one of the principal operational challenges for the Brazilian screening program.

The incorporation of Fecal Immunochemical Test into the Brazilian Unified Health System aligns Brazil with internationally established colorectal cancer screening strategies. The new policy expands screening coverage, prioritizes colonoscopy for individuals at higher risk of colorectal neoplasia, and establishes a scalable model capable of reaching a substantially larger proportion of the eligible population despite the country’s continental dimensions and regional healthcare disparities.

Written by Marianne Potengy