In screening for colorectal cancer, is the fit right for the right side of the colon?
Menée en Italie à partir de données portant sur 123 347 personnes âgées de 50 à 69 ans ayant participé entre 2002 et 2014 à six sessions d'un programme de dépistage du cancer colorectal comportant un test immunochimique de recherche de sang occulte dans les selles (FIT), cette étude évalue, en fonction de la localisation (côlon proximal, côlon distal ou rectum) et du point de vue des taux de détection d'adénomes de stade avancé et de lésions cancéreuses, l'efficacité du test FIT
Colorectal cancer (CRC) is a leading cause of cancer mortality, with an estimated 881 000 deaths worldwide in 2018 (1). Colorectal cancer mortality rates have been decreasing in many industrialized countries in recent decades, driven—at least in part—by increased screening (2), underscoring the importance of expanding the reach of screening in communities. However, gaps in the evidence regarding currently available strategies still present a challenge when deciding how to optimize the detection of clinically important lesions throughout the colon. The fecal immunochemical test (FIT) is one of the most commonly used CRC screening methods worldwide; it is moderately sensitive, noninvasive, and easy for patients to complete. However, the evidence for its use is extrapolated from trials of guaiac-based fecal occult blood tests. Although research has shown that stool-based tests are less sensitive in detecting right- than left-sided cancer (3), few long-term studies have been published to help gauge the ability of these tests to reduce the risk for death from right colon cancer over several screening rounds, as recommended by guidelines.
Annals of Internal Medicine , éditorial, 2017