Early FIT Screening Yields Reductions in CRC Mortality
A 19-year observational study of more than 263,000 participants in Taiwan found that initiating fecal immunochemical test (FIT) screening at age 40 to 49 years was associated with further reduction in colorectal cancer (CRC) mortality and incidence compared with starting screening at age 50 years.
“The rising incidence of young-onset colorectal cancer (CRC) has prompted health policymakers to consider lowering the recommended starting age for screening,” the authors wrote in JAMA Oncology. “However, population-based evidence supporting the long-term effectiveness of early-age screening remains limited.”
Participants were divided into subcohorts based on early FIT screening at age 40 to 49 years and later regular CRC screening at 50 years and older, including 39,315 who underwent early and regular screening; 13,827 who underwent early screening only; 223,810 who underwent regular screening only; and 224,087 who underwent no regular screening. CRC incidence and mortality rates in these subcohorts at 5 years were compared to evaluate long-term benefits.
Data were collected from January 2001 to December 2019, and data were analyzed from January 2021 to December 2024. Primary outcomes were CRC incidence and mortality rates, reported as cases per 100,000 person-years, with adjusted relative risks (aRRs) comparing early vs regular screening groups.
“Biennial FIT screening was initiated for the early screening group at ages 40 to 49 years and for the regular screening group at age 50 years, with follow-up continuing under Taiwan’s national screening program,” the authors wrote. “Of 263,125 participants, 39,315 participated in early and regular screening, and 223,810 participated in regular screening only. The early screening group exhibited lower CRC incidence (26.1 [95% CI, 22.3-29.9] vs 42.6 [95% CI, 40.5-44.7] per 100,000 person-years) and mortality (3.2 [95% CI, 1.9-4.6] vs 7.4 [95% CI, 6.5-8.2] per 100,000 person-years).”
Propensity score–matched analyses indicated that early screening significantly reduced CRC incidence (aRR, 0.79; 95% CI, 0.67-0.94) and mortality (aRR, 0.61; 95% CI, 0.38-0.98). “Findings were consistent in the extended nonadherence adjustment model, showing a 25% reduction in incidence (aRR, 0.75; 95% CI, 0.72-0.77) and a 34% reduction in mortality (aRR, 0.66; 95% CI, 0.62-0.71),” the authors concluded.
Reference:
Chiu H-M, Li-Sheng Chen, S, Su C-H. Long-term effectiveness associated with fecal immunochemical testing for early-age screening. JAMA Oncol. Published Online: June 12, 2025. doi: 10.1001/jamaoncol.2025.1433
