Colonoscopy is the preferred screening method for first-degree relatives (FDRs) of colorectal cancer patients. But evidence supporting the use of colonoscopy in this high-risk population remains indirect, with no randomized trials showing a reduction in CRC incidence or mortality. Recently, screening with fecal immunochemical testing in average-risk populations has gained widespread adoption, mainly because of its low cost, ease of use, and moderate sensitivity and high specificity for CRC. However, despite the fact that FIT is an accepted screening strategy in the average-risk population, little is known regarding FIT’s ability to detect advanced neoplasia in FDRs of CRC patients.
Dr. Quintero and his colleagues are to be congratulated for performing a randomized trial comparing the efficacy of repeated annual FIT versus a one-time colonoscopy in detecting advanced neoplasia in FDRs of CRC patients.
However, despite the study’s statistical significance in demonstrating equivalence between the two screening modalities, there was still a marked absolute difference in detecting advanced neoplasia between the two tests. Furthermore, the usefulness of FIT screening as an alternative to colonoscopy in this high-risk population will depend on patient uptake. The current study was unable to address this issue because participants knew they could opt out of their assigned strategy and still participate in the study, which was seen in the high crossover rate from the FIT group to the colonoscopy group.
These issues aside, the Quintero study provides important information about alternative screening modalities for the detection of advanced neoplasia in FDRs of CRC patients, and paves the way for future clinical studies.