Smartphone-Based FIT Shows Comparable Performance to Laboratory Testing for Colorectal Cancer Screening
A smartphone-based fecal immunochemical test (FIT) demonstrated diagnostic performance similar to a standard laboratory-based FIT in a prospective screening study, suggesting a potential role as an adjunct option to improve colorectal cancer (CRC) screening participation.
Between 2021 and 2023, individuals scheduled for screening colonoscopy in Southern Germany were offered both a laboratory FIT and a smartphone-based FIT. The smartphone test paired a rapid FIT cassette with a mobile application that used the phone’s camera to quantitatively interpret results. Participants completed a questionnaire assessing usability and acceptance.
Of 654 participants offered both tests, 55% opted to use the smartphone-based FIT, compared with 98% who completed the laboratory FIT. Among smartphone test users, 76% generated a valid result. Acceptance was generally favorable, with 89% of participants indicating that the smartphone-based FIT was “a useful alternative offer to the laboratory FIT.”
Nonuse of the smartphone-based test was largely attributed to technical barriers or user concerns. App- or smartphone-related issues accounted for 47% of nonuse, while 44% reflected broader reservations about using a smartphone-based medical test. These findings highlight practical challenges that may limit uptake despite patient interest.
Diagnostic performance was comparable between the two approaches. The smartphone-based FIT detected advanced colorectal neoplasms with a sensitivity of 28% (95% CI, 13%–47%), similar to the laboratory FIT sensitivity of 34% (95% CI, 18%–54%), when both were evaluated at the same specificity of 92%. Receiver-operator curve analyses further supported similar test characteristics.
The investigators concluded that “the smartphone-based FIT could serve as an alternative in addition to currently offered laboratory FITs.” For gastroenterologists, the key takeaway is that smartphone-enabled screening tools may complement existing CRC screening strategies, particularly for patients hesitant to engage with traditional testing pathways.
While laboratory FIT remains the standard, offering a smartphone-based option could broaden access and participation if technical barriers are addressed. The results support further exploration of digital screening tools as part of flexible, patient-centered CRC prevention programs.
Reference
Hoffmeister M, Seum T, Ludwig L, Brenner H. Performance of a smartphone-based stool test for use in colorectal cancer screening: population-based study. Clin Gastroenterol Hepatol. 2026;24(1):241-249.e3. doi:10.1016/j.cgh.2025.04.027
