From the Guidelines
A Fecal Immunochemical Test (FIT) is indicated for a patient over 50 years old with chronic abdominal pain and no prior colorectal cancer screening, but colonoscopy is the preferred initial screening method due to the presence of symptoms. The FIT test detects hidden blood in the stool, which can be an early sign of colorectal cancer or polyps, but it may not adequately evaluate the cause of chronic abdominal pain 1. For symptomatic patients over 50, especially with no prior screening, a colonoscopy offers direct visualization of the colon and allows for immediate biopsy or removal of concerning lesions. This approach is more appropriate because chronic abdominal pain could indicate various conditions including inflammatory bowel disease, diverticulitis, or colorectal cancer.
Key Considerations
- The American Family Physician recommends screening for colorectal cancer in asymptomatic adults 50 years and older who are at average risk of colorectal cancer and who do not have a family history of known genetic disorders that predispose them to a high lifetime risk 1.
- The U.S. Multi-Society Task Force on Colorectal Cancer recommends that CRC screening should begin at age 50 years in asymptomatic persons, with colonoscopy every 10 years and annual FIT being the first considerations for screening 1.
- If colonoscopy is not immediately available or the patient refuses, a FIT test could be used as an interim measure, but a negative FIT would not rule out non-bleeding causes of abdominal pain, and further evaluation would still be necessary regardless of the FIT result.
Screening Options
- Colonoscopy every 10 years
- Annual FIT
- FIT-DNA every 1 or 3 years
- CT colonography every 5 years
- Flexible sigmoidoscopy every 5 years
- Flexible sigmoidoscopy with FIT every 10 years plus FIT every year It is essential to note that the choice of screening method should be based on patient preferences, medical history, and risk factors, as well as the availability of resources and expertise 1.
From the Research
Indications for Fecal Immunochemical Test (FIT)
- The Fecal Immunochemical Test (FIT) is indicated for patients over 50 years old with no prior colorectal cancer screening, as it is a recommended screening test for average-risk individuals 2, 3, 4.
- According to the U.S. Multi-Society Task Force on Colorectal Cancer, FIT is a first-tier test, along with colonoscopy, and is recommended as a cornerstone of screening regardless of how screening is offered 2.
- The US Preventive Services Task Force recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years, with FIT being one of the recommended screening strategies 4.
Considerations for Patients with Chronic Abdominal Pain
- While chronic abdominal pain may be a symptom of colorectal cancer, the decision to use FIT as a screening test should be based on the patient's overall health and screening history, rather than the presence of symptoms alone 2, 4.
- The American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy recommend that FIT be offered to patients who decline colonoscopy or as part of a risk-stratified approach 2.
Screening Recommendations
- The recommended screening interval for FIT is annual 2, 3.
- Patients with a family history of colorectal cancer or a documented advanced adenoma in a first-degree relative may require more frequent screening or a different screening strategy 2.
- The decision to discontinue screening should be individualized, taking into account the patient's overall health, prior screening history, and life expectancy 2, 4, 5.