Colorectal cancer (CRC) is a significant public health concern, and routine screening is crucial for early detection and prevention.
Fecal immunochemical tests (FIT) are widely used for CRC screening, offering a non-invasive and cost-effective approach.
However, a recent study has highlighted important challenges related to FIT, including unsatisfactory sample collection and follow-up, particularly in underserved populations.
FIT as a Screening Tool
Fecal immunochemical tests are self-collected examinations that detect hidden blood in stool samples.
These tests are recommended for CRC screening in individuals aged 45 to 75, offering an accessible alternative to colonoscopy for many, especially those from lower-income and medically underserved communities.
Challenges in FIT Screening
The study, led by Rasmi Nair, MBBS, Ph.D., and Po-Hong Liu, MD, focused on assessing the effectiveness of FIT screening within the Dallas-based Parkland Health system, a safety-net healthcare provider primarily serving uninsured, lower-income, and racial/ethnic minority individuals.
The research aimed to identify challenges in the FIT screening process.
Unsatisfactory FIT Samples
The study revealed that more than 10% of FIT samples were unsatisfactory and could not be processed.
The reasons for unsatisfactory samples included inadequate specimen (51%), incomplete labeling (27%), sample age (13%), or container issues (8%).
This finding underscores the importance of addressing these issues to enhance the reliability of FIT screening.
Another concerning finding was that only 40.7% of individuals with unsatisfactory FIT results received follow-up screening or colonoscopy within 15 months.
This gap in follow-up care highlights the need for a more comprehensive approach to identifying and addressing unsatisfactory FIT results.
The study also identified disparities in FIT completion. Black patients were 1.46 times more likely to submit unsatisfactory tests, while Spanish-speaking patients were 1.12 times more likely to do the same.
These disparities underscore the importance of reducing language, literacy, and logistical barriers to successful screening.
Suggested Solutions: To improve FIT screening, the study suggests several potential solutions, including:
- Wordless or low-literacy instruction materials to overcome language and literacy barriers.
- Pre-affixed patient labels or barcodes to minimize labeling errors.
- Automated systems for identifying and contacting patients with unsatisfactory tests.
Conclusion and Implications
The study highlights the challenges faced in implementing FIT screening, particularly in underserved populations.
Addressing issues related to unsatisfactory samples and ensuring timely follow-up are critical steps to enhance the effectiveness of CRC screening programs.
Additionally, minimizing disparities in screening completion is essential for equitable healthcare access. Future efforts should focus on implementing these solutions to improve CRC screening outcomes and save lives.
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The research findings can be found in Cancer Epidemiology, Biomarkers & Prevention.
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