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Age-adapted Variation in Screening Interval of Fecal Immunochemical Test May Improve its Participation and Colonoscopy Acceptance

Kwak, Min Seob MD; Cha, Jae Myung MD, PhD; Yoon, Jin Young MD; Jeon, Jung Won MD, PhD; Shin, Hyun Phil MD, PhD; Joo, Kwang Ro MD, PhD; Lee, Joung Il MD, PhD

Journal of Clinical Gastroenterology: October 2017 - Volume 51 - Issue 9 - p 825–830
doi: 10.1097/MCG.0000000000000743
ALIMENTARY TRACT: Original Articles

Goals: We determined appropriate intervals for administering the fecal immunochemical test (FIT) and performance outcomes in an Asian national colorectal cancer (CRC) screening program.

Background: The optimal interval for FIT in CRC screening is unclear, especially in Asian populations.

Study: Between January 2009 and December 2015, 13,480 individuals aged 50 years or older with an initial negative FIT result underwent 2 rounds of FIT screening at intervals of 1 (annual group, 5333), 2 (biennial group, 7363), or 3 years (triennial group, 784). Positive rates of FIT, colonoscopy acceptance, colonoscopy findings, and detection rates for CRC and advanced neoplasia were compared according to FIT intervals.

Results: The overall positivity rate of FIT in the second screening round was significantly higher in men and in older subjects than in the entire sample. Younger subjects were less likely to undergo annual FIT (36.0% vs. 46.4%, P<0.001). The colonoscopy acceptance rate was decreased in the biennial and triennial groups compared with an annual group among younger subjects (odds ratio, 0.56; 95% confidence interval, 0.33-0.95 for the biennial group vs. odds ratio, 0.19; 95% confidence interval, 0.03-1.37 for the triennial group). Detection rates for CRC and advanced neoplasia in the second round were significantly higher and accompanied by increased FIT screening intervals in older, but not younger subjects.

Conclusions: Age-adapted variation in FIT screening intervals, such as annual screening for elderly subjects and biennial screening for younger subject, may improve FIT participation and colonoscopy acceptance.

Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University College of Medicine, Seoul, Korea

M.S.K. and J.M.C.: contributed to the conception and design of the study. J.Y.Y., J.W.J., H.P.S., K.R.J., and J.I.L.: responsible for acquisition, analysis, and interpretation of data. M.S.K. and J.M.C.: drafted the manuscript.

The authors declare that they have nothing to disclose.

Address correspondence to: Jae Myung Cha, MD, PhD, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 149 Sangil-dong, Gangdong-gu, Seoul 134-727, Republic of Korea (e-mail:

Received May 26, 2016

Accepted October 1, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.