At-home bowel cancer screening could reduce colonoscopy need

Screening for bowel cancer using at-home faecal immunochemical tests (FITs) may help to reduce the frequency of colonoscopies for some above-average risk individuals, a new pre-print study has found.
 
The research, which was published in the journal Clinical Gastroenterology and Hepatology but has yet to be peer-reviewed, also indicates a low risk of advanced tumours following multiple negative tests.
 
The paper’s lead author, Dr Molla Wassie from the Flinders Health and Medical Research Institute, says people at a high-risk are encouraged to undertake surveillance colonoscopies every 1–5 years, depending on their family history and prior colonoscopy results, but this approach has drawbacks.
 
‘Due to the risks, costs and burden on the healthcare system from surveillance colonoscopies for bowel cancer, there is a need to explore how we can further personalise screening intervals,’ he said.
 
‘Faecal immunochemical tests could be one way of identifying those who could extend their surveillance interval out further.’
 
The retrospective study involved more than 3300 people enrolled in the Southern Cooperative Program for the Prevention of Colorectal Cancer (SCOOP), a South Australian-based bowel cancer surveillance program.
 
Participants had no bowel cancer found at their previous colonoscopy and had been recommended to have another in 3–5 years. They completed a two-sample FIT – the same test used in the Australian National Bowel Cancer Screening Program (NBCSP) – between colonoscopies, from 1–4 rounds at 1–2 yearly intervals, each with a negative result.
 
The risk of the follow-up colonoscopy identifying advanced neoplastic lesions including cancer following a negative FIT was around one in 10, with this risk decreasing further with every subsequent negative result, reaching 5.7% after four negative tests.
 
‘We conducted this study to find out if we could use the home stool screening test to determine which individuals are at lower risk for bowel cancer, or pre-cancerous findings, to then hopefully be able to reduce how often they need colonoscopy,’ co-author Associate Professor Erin Symonds said.
 
‘This might be a way that we can safely reduce the burden on healthcare resources.’
 
The authors say the results support the use of FITs to further personalise cancer surveillance intervals and reduce the overall frequency of colonoscopies.
 
‘Like any surgery, a colonoscopy can be invasive and carries risks for the patient,’ Dr Wassie said.
 
‘Add this to access issues, costs and the burden it places on our already strained healthcare system and there is a significant need to ensure current recommendations are suitable.
 
‘In colonoscopy surveillance programs in Australia, intervals up to 10 years between colonoscopies have recently been suggested as a suitable timeframe for cancer surveillance after low-risk findings.’
 
While the study supports the introduction of annual at-home FITs into surveillance programs, Dr Wassie said uptake and adherence would be a ‘key factor’ in its success.
 
GPs play a crucial role in promoting bowel cancer screening participation, with the University of Melbourne’s Professor Jon Emery previously telling newsGP they are ideally placed to help.
 
‘GPs are key to discussions around cancer screening, to promoting both informed choices in … screening and increased participation, particularly in the NBCSP,’ he said.
 
‘One of the most effective strategies [for reducing bowel cancer deaths] is really to try and increase participation.
 
‘General practice plays a key role in promoting the program and checking that patients are up to date with their bowel cancer screening.’
 
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