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Hépato-Gastro & Oncologie Digestive

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Colorectal cancer screening with faecal occult blood testing using quantitative immunochemical test: a revolution? Volume 22, issue 2, Février 2015

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Authors
1 Hôpitaux Civils de Colmar, Service de Médecine A, 39 avenue de la Liberté, 68024, Colmar Cedex, France
2 Inserm U1086 « Cancers & Préventions », Centre François Baclesse, Avenue du Général Harris, 14076, Caen Cedex 05, France
* Tirés à part

The French colorectal cancer (CRC) screening programme is dedicated to average risk men and women aged 50 to 74 years. They are invited every two years for a CRC screening test using a guaiac-based faecal occult blood test (gFOBT). This test will be replaced by a quantitative faecal immunochemical test (FIT) in 2015. The sensitivity of the latter for the detection of CRCs and advanced adenomas is enhanced, at the cost of an increased positivity rate and a decreased specificity. The main advantage of quantitative FITs is their greater ease of use: one sample is enough instead of six for gFOBTs. Participation of the invited population is thus always enhanced, by 5 to 13% depending on studies. By contrast, FIT stability is less than that of gFOBT with a shorter duration of use (18 months) and a shorter maximum time period between collection and analysis (7 days). The impact of screening using FIT on CRC mortality is not known with the same precision as that of gFOBT screening. Taking into account their better analytical performance, the CRC mortality reduction should be greater using FITs than gFOBTs, and might be associated with a CRC incidence reduction. Overall, quantitative FIT represents real progress for CRC screening in average risk people, not a revolution. FIT remains an FOBT that retains all the drawbacks of a faecal test. By contrast, the very good performance of quantitative FITs has the potential to revolutionise practices in high CRC risk people (personal or family history of colorectal neoplasia) and symptomatic patients. The indication to perform a colonoscopy could be based on the result of a triage quantitative FIT that could be included in scoring systems to identify individuals at high risk for advanced colorectal neoplasia.