From the Guidelines
In Alberta, it is recommended to discontinue Fecal Immunochemical Test (FIT) screening for colorectal cancer at age 75, as the benefits of continued screening decrease while the risks of follow-up procedures like colonoscopy increase, as suggested by the American College of Physicians in 2019 1. The decision to stop screening should ultimately be individualized based on overall health status, life expectancy, and personal preferences, ideally through a discussion between the patient and their healthcare provider. Some key points to consider when deciding to discontinue FIT testing include:
- The average time to prevent 1 death from CRC for 1000 patients screened was 10.3 years, as reported in pooled results of gFOBT RCTs 1
- The American College of Physicians recommends discontinuing screening for colorectal cancer in average-risk adults older than 75 years or in adults with a life expectancy of 10 years or less 1
- The USPSTF does not recommend routine screening for adults 75 to 85 years of age and recommends against screening adults older than 85 years of age, as stated in their 2008 recommendation statement 1 However, the most recent and highest quality study, published in 2019 by the American College of Physicians, takes precedence in guiding the decision to discontinue FIT testing 1. It is essential to weigh the potential benefits of early cancer detection against the risks of complications from diagnostic procedures in older adults. Those with specific risk factors for colorectal cancer may require different screening approaches or timelines.
From the Research
Discontinuation of FIT Testing in Alberta
There is no direct evidence in the provided studies to determine the age at which to discontinue FIT testing in Alberta. However, the studies provide information on the effectiveness of FIT testing in different age groups.
- The studies suggest that FIT testing is effective in detecting colorectal cancer and advanced neoplasia in individuals aged 50-75 years 2, 3, 4, 5.
- One study found that lowering the recommended screening age to 45 or 40 years using FIT testing could increase colonoscopy demand and reduce incidence and mortality from colorectal cancer 6.
- The optimal age to discontinue FIT testing is not explicitly stated in the studies, but it can be inferred that it may depend on individual risk factors and screening history.
Considerations for Discontinuation of FIT Testing
When considering discontinuation of FIT testing, the following factors should be taken into account:
- Individual risk factors, such as family history of colorectal cancer or previous history of adenomas or colorectal cancer
- Screening history, including previous FIT test results and colonoscopy findings
- Age and overall health status
- Current guidelines and recommendations for colorectal cancer screening in Alberta
Future Research Directions
Further research is needed to determine the optimal age to discontinue FIT testing in Alberta, taking into account individual risk factors and screening history. Studies should investigate the cost-effectiveness and clinical effectiveness of different screening strategies, including FIT testing and colonoscopy, in different age groups and populations 6, 5.