After Unsuccessful FIT, Most Patients Fail to Test Again

Less than half of patients who returned a fecal immunochemical test (FIT) that could not be processed completed a subsequent test in the next 15 months, according to study results published online ahead of print in Cancer Epidemiology, Biomarkers & Prevention.

The retrospective study looked at the prevalence of unsuccessful FIT in 56,980 adults from a safety-net health system, ages 50 to 74 years, who were at average risk for colorectal cancer and completed an index FIT. The tests were performed at health care offices or via a mail order system. Patients who used the mail order system were automatically sent a repeat test if the initial FIT was unsatisfactory.

According to the findings, 10.2% of patients had an unsatisfactory FIT. Reasons tended to be patient-related and included inadequate specimens (51%), incomplete labeling (27%), old specimens (13%), and broken or leaky containers (8%).

Factors associated with an unsatisfactory FIT included receiving FIT by mail (researchers reported a 2.66 odds ratio) and being Black (1.46 odds ratio), on Medicaid (1.42 odds ratio), Spanish-speaking (1.12 odds ratio), and male (1.10 odds ratio).

Just 41% of patients with an unsatisfactory FIT completed a subsequent test within 15 months, the study found. Adults 54 years or younger and those who received FIT by mail were more likely to complete a subsequent test.

Instruction pamphlets with fewer or no words, preaffixed labels, and automated systems for contacting patients with an unsatisfactory FIT could improve testing success, researchers suggested.

“Screening programs should address these breakdowns, such as specimen collection and labeling, to improve real-world effectiveness,” wrote corresponding author Rasmi Nair, MBBS, PhD, of the University of Texas Southwestern Medical Center in Dallas, and study coauthors.

References:
Liu PH, Nair RG, Skinner CS, et al. Unsatisfactory fecal immunochemical tests for colorectal cancer screening: prevalence, reasons, and subsequent testing. Cancer Epidemiol Biomarkers Prev. Published online November 15, 2023. doi:10.1158/1055-9965.EPI-23-0507

More than 10% of samples from a stool-based colorectal cancer test may be unsatisfactory. News release. American Association for Cancer Research; November 15, 2023. Accessed December 7, 2023.