Reporting interim findings from a multi-institutional assessment of more than 50,000 people 50 to 69 years of age, COLONPREV Study Group investigators from Spain have concluded colonoscopy is better than fecal immunochemical testing (FIT) at detecting adenomas.
About two-thirds of colonic polyps are adenomas, and while most adenomas do not develop into cancer, larger adenomas have a greater potential for malignancy.
For this randomized controlled trial, reported in the February 23 issue of the New England Journal of Medicine, Enrique Quintero, MD, PhD, from the Hospital Universitario de Canarias, in Tenerife, Spain, and coauthors compared one-time colonoscopy in 26,703 enrolled subjects against FIT performed every 2 years in a group of 26,599 subjects.
The rate of death from colorectal cancer at 10 years was the primary outcome for the study. The investigators found that subjects in the FIT group were more likely to participate in screening than those in the colonoscopy group (34.2% vs 24.6% rates of participation, respectively, P < .001).
Notably, however, while colorectal cancer detection rates were similar at baseline screening examination in the FIT and colonoscopy groups (0.1% in each group), advanced adenomas were detected in 514 subjects (1.9%) in the colonoscopy group vs 231 (0.9%) in the FIT group (P < .001).
Nonadvanced adenomas were detected in 1,109 subjects (4.2%) in the colonoscopy group and 119 (0.4%) in the FIT group (P < .001). (The ClinicalTrials.gov number of this study is NCT00906997.)