Toufic Kachaamy: A well-implemented FIT program can approach the long-term effectiveness of a one-time offer for a colonoscopy
Toufic Kachaamy, Chief of Medicine and Director of Gastroenterology at City of Hope, shared a post on LinkedIn about a paper by Antoni Castells et al. published in The Lancet:
“A study just published in the Lancet regarding invitation to colonoscopy vs FIT testing and showed FIT to be non-inferior to colonoscopy.
Here are some important things to consider regarding the study:
First, to quote the authors:
‘Rather than evaluating the efficacy of colonoscopy and faecal immunochemical test techniques, the present study investigated how they performed in programmatic colorectal cancer screening’
This means that this study was not designed to determine how effective colonoscopy is but to evaluate the effectiveness of a one time invitation letter to colonoscopy vs 5 total invitations to stool testing with FIT (every other year).
For gastroenterologists and primary care physicians, the message is not that ‘FIT is as good as colonoscopy,’ but that a well-implemented FIT program can approach the long-term effectiveness of a one-time offer for a colonoscopy.
The context is key: this trial leveraged the higher acceptability of FIT to achieve nearly equal cancer outcomes at 10 years in a population where the majority did not get the colonoscopy.
It highlights how crucial patient adherence and program design are; the best test is the one your population will actually do. Importantly, these findings shine a light on colonoscopy’s current limitations in practice: e.g. participation barriers, variability in quality, and missed lesions.
Rather than undermining colonoscopy, it should motivate us to innovate and improve it. This is exactly the driving force behind EndoInnovate to tackle the weaknesses of today’s colonoscopy and boost its effectiveness.
By improving prep quality, visualization, polyp detection technology, and patient experience, we aim to ensure that future colonoscopy screening truly prevents more cancers and saves more lives.
Bottom line: In a real-world setting, less invasive FIT screening can achieve similar lifesaving benefits to a one time invitation to colonoscopy screening at 10 years – largely because more people do it.
For an individual willing to have a colonoscopy it remains unbeaten in its effectiveness to detect and prevent cancer.
As we celebrate this progress in non-invasive screening, let’s also push forward with innovations to make colonoscopy easier, more accurate, and more impactful. After all, increasing options and improving tools will only advance our ultimate goal: zero preventable colorectal cancer deaths to save 150,000 lives per year in the USA.”
Authors: Antoni Castells, Enrique Quintero, Luis Bujanda, Susana Castán-Cameo, Joaquín Cubiella, Jesús Banales, Vicent Hernández, Isabel Portillo, Mercedes Vanaclocha-Espí, Mariola de la Vega et al.
More posts featuring Toufic Kachaamy.
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