geoffrey modest medical blogs

  A recent Chinese study suggested that a targeted, “risk-adapted” approach to colorectal cancer (CRC) screening might be the optimal one (see  colon ca screening colo vs fit vs risk-stratified ClinGastrHep2022  in dropbox, or doi.org/10.1016/j.cgh.2022.08.003),   a pre-print, pre-peer reviewed article   Details:   --19,373 people from 5 provinces in China were randomized to one of 3 screening arms:      -- one-time colonoscopy (n=3883)      -- annual fecal immunochemical test (FIT test, n=7993)          -- FIT test done was self-administered point-of-care qualitative test, with “a positivity threshold of 8mg Hb/g feces”, “comparable to the laboratory-based quantitative FIT”      -- “risk-adapted screening”, whereby those judged to be at high risk were referred directly for colonoscopy, and those low risk to annual FIT testing      ...

  a recent Taiwanese study found that biennial fecal immunochemical test (FIT testing) led to large reductions in both advanced colorectal cancer (CRC) and deaths from CRC (see   colon ca screening FIT dec mortality gut2021  in dropbox, or doi. org/ 10. 1136/gutjnl- 2020- 322545). Details: --nationwide prospective study of 5,417,699 people aged 50-69 invited for screening from 2004-9, with follow-up until 2014 --3,067,853 had at least one FIT screen and 2,349,846 did not receive any     --1,065,200 had at least 2 rounds of FIT tests --overall screening rate was 57% --those with positive FITs were referred for colonoscopy within 3 months     --70% of FIT-positive subjects had diagnostic screening, 90% of which was colonoscopy --advanced stage CRC was defined as stage II+ --a total of 6756 CRCs were diagnosed on the first screen and 3118 on subsequent rounds (ie, detection rate of about 2/1000 FITs) Results: --FIT testing, comparing those screened to the...