Survival Benefit of Single Fecal Immunochemical Test as Initial Screening for Colorectal Cancer in Two Districts in Roi Et Province, Thailand
Wachara Eamratsameekool MD1, Piti Tangpaisan MD1, Piyalak Phakdeesamai MS1, Paiboon Pensuwan MD2, Chanthip Poonlab MD2, Kriengkrai Kovitangkun MD2, Teerapat Ungtrakul MD3,4, Bunchorn Siripongpreeda MD3,4
Affiliation : 1 Roi Et Provincial Health Office, Roi Et, Thailand 2 Roi Et Hospital, Roi Et, Thailand 3 Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand 4 Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
Objective : To determine a survival benefit from colorectal cancer [CRC] screening protocol that uses fecal immunochemical
test (FIT) as initial screen, followed by colonoscopy for abnormal results.
Materials and Methods : Between November 2009 and March 2010, we enrolled 9,755 (out of 30,563) residents aged 50
years or older in the Phanomphrai and Nonghi, Roi Et, Thailand for fecal occult blood test [FOBTs] using FIT. Those with
positive results were referred to the colonoscopy service at Roi Et Hospital. We analyzed the end point: CRC death up to
2016.
Results : Of 9,755 tested subjects, 828 (8.5%) had positive FOBT results, of whom 197 had abnormal pre-operative
assessments. The remaining 631 were referred to the colonoscopy service, of whom 183 subsequently underwent polypectomy
and 10 were found to have colorectal adenocarcinoma. No patients who had positive FIT results and underwent colonoscopy
died of CRC, compared with 0.19% among those with negative FIT results, 2.03% among subjects who declined to undergo
colonoscopy, and 0.14% for those who did not enroll in the initial screening program.
Conclusion : Single FIT followed by colonoscopy for positive results can detect early CRC and has a survival benefit as
initial colorectal screening.
Keywords : Colorectal cancer screening, Fecal immunochemical test, Fecal occult blood test, Population-based screening
