JS, van Turenhout Several recently published guidelines support the use of FIT for screening of average-risk participants.44,45 The Canadian Task Force on Preventive Health Care excludes colonoscopy as a primary screening test and recommends screening only with FIT, guaiacbased fecal occult blood tests, or flexible sigmoidoscopy.46 Our results are in line with these suggestions and support use of FIT for screening of increased-risk individuals. JD, Armitage Our search identified 3026 records (Figure 1). The test isn't always accurate. TR, FIT only detects human blood from the lower intestines. Continuing without changing cookie settings assumes you consent to our use of cookies on this device. Washington, DC 20001 TH, et al. Colonoscopy is an invasive, expensive procedure with an established risk of complications.40,41 Population-based studies and randomized trials suggest that adherence to use of colonoscopy for screening in average and increased-risk populations is usually suboptimal.42 This undermines the efficacy of screening programs43 and underlines the need for alternative screening modalities that may limit the need for colonoscopy only to those participants with positive results. midas: meta-analysis of diagnostic accuracy studies. Fecal immunochemical test (FIT). Advanced colonic neoplasia in the first degree relatives of colon cancer patients: A colonoscopy-based study. This is especially important for those who are averse to colonoscopy. Equivalency of fecal immunochemical tests and colonoscopy in familial colorectal cancer screening. Main Characteristics of Studies Included in the Systematic Review and Meta-analysis, Table 2. Quantitative and 1-sample FIT showed adequate test performance, but data on other FIT brands and multiple samples were insufficient. The greatest risk for bias occurred owing to flow and timing. Deeks et al. According to a 2014 clinical study, about 13% of results from Cologuard were false positives and 8% were false negatives. independently reviewed and screened titles and abstracts of articles retrieved and determined final eligibility through examination of full texts. To our knowledge, this is the first systematic review and meta-analysis evaluating the diagnostic accuracy of FIT in individuals at increased risk for CRC. The observed trend toward a reduction of the protective effect of FIT screening with increasing interval since the last negative test also is consistent with previous findings. Further research is needed to assess whether this relationship . Quintero Bacchus S, ed. What is a FIT? Terms of Use| Mean age ranged from 46.0 to 63.2 years, and percentage of males ranged from 30.2 to 50.6%. DA, McFarland Quality assessment summary: review authors judgments about each risk of bias item for each included study, eFigure 3. Can miss many polyps and some cancers. and P.P.) Fecal immunochemical test (FIT) No direct risk to the colon. Also, please keep in mind the percentage of positive tests that lead to cancer, I think it's somewhere around 3%. PM, Zwinderman Hierarchical models were used to synthesize available evidence. Lee Conclusions and Relevance Among patients with a positive fecal immunochemical test result, compared with follow-up colonoscopy at 8 to 30 days, follow-up after 10 months was associated with a higher risk of colorectal cancer and more advanced-stage disease at the time of diagnosis. Quiz Ref IDDespite the use of an exhaustive and meticulous search strategy, we could only find 12 eligible studies. 2017;177(8):11101118. We included studies that reported the diagnostic accuracy of FIT for CRC or advanced neoplasia (CRC, or adenomas 10 mm or with 25% villous component and/or high-grade dysplasia) in asymptomatic adults with family history of CRC or personal history of CRC or advanced adenomas and used colonoscopy or follow-up as the reference standard. In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., Colonoscopy after Positive FIT Test Cuts Risk of Colorectal Cancer Death was originally published by the National Cancer Institute., January 12, 2023, Methods The FIT-based CRC screening programme in the Veneto region (Italy) invited persons aged 50 to 69 . This points to one possible reason why people in this group, on average, were less likely to get follow-up colonoscopy exams, Dr. Corley said. This is especially important for those who are averse to colonoscopy. Eligible studies had to provide quantitative information on sensitivity and specificity or sufficient information to calculate them, and/or the area under the ROC curve (AUC/c statistic) for detection of CRC, AA or any advanced neoplasm (AN), and examine these outcomes for FIT alone and for the combination of FIT and a blood (serum/plasma) test. Lastly, she said that 3 out of four people have polyps, hemorrhoids, ulcers, or a combination of the three. In one study, researchers obtained fecal samples from 435 patients with newly diagnosed CRC, calculating sensitivities of aquantitative FIT at cutoffs recommended by the manufacturer and at alternative cutoffs for tumors at different stages. At 76.6-85.8%, 1 the specificity of FIT at a cut-off of 10 is relatively high but this means that up to 25% of patients will have a false-positive result. R, Carlos A positive FIT test is concerning. Results for all subgroup analyses are summarized in Table 2. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. Applying Grading of Recommendations Assessment, Development and Evaluation (GRADE) to diagnostic tests was challenging but doable. What is the diagnostic accuracy of fecal immunochemical testing (FIT) for screening of colorectal cancer (CRC) or advanced neoplasia in asymptomatic high-risk populations? Several limitations have to be acknowledged about the evidence and the review itself. Effect of Single-Dose Aspirin Prior to FIT on Colorectal Cancer Detection. D, Hernndez-Guerra Needs to be done every year. // Levi FIT testing is recommended annually, and Cologuard every three years if testing is negative, but positive test results require a follow-up with colonoscopy. About 60% of the time, they'll find nothing; about 35%, a polyp; about 4%, a very early cancer; about 1% a less early cancer. AZ, Quiz Ref IDColorectal cancer (CRC) is the third most common type of cancer in men and the second most common in women worldwide.1 Early detection of CRC through widely applied screening programs has proven to be effective in reduction of cancer-related mortality. The positive result could be caused by a stomach ulcer, hemorrhoids, other inflammation. Colorectal cancer (CRC) is the third most common type of cancer in men and the second most common in women worldwide. et al; QUADAS-2 Group. The main findings of our study. // Used not only as a screening test, colonoscopies are also used as a diagnostic procedure to follow up after positive results from a fecal occult blood test (FOBT) or fecal immunochemical test (FIT), fecal DNA test, sigmoidoscopy . [This] raises the importance of being able to get the individual steps correct and completed as best you can because every step where you lose some people in follow-up can have a big impact., Study Adds to Debate about Screening for Melanoma, Ivosidenib with Chemotherapy New Option for Some People with AML, If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions. The rate of early-stage disease was also higher in this group (51.3%) than in the group 2 (45.5%). It looks for tiny traces of blood that you might not be able to see and which could be a sign of cancer. Cologuard found 93 percent of the cancers detected by screening colonoscopy. A proposal to standardize reporting units for fecal immunochemical tests for hemoglobin. C, Zubiaurre Multiple factors can contribute to people not getting follow-up colonoscopy exams, both he and Dr. Breslau said. FA, Yet theres clearly room for improvement. A single FIT test detects about 73 percent of colorectal cancers. Specifically, the investigators wanted to see if a colonoscopy identified any cancer missed by the FIT. If FIT testing is utilized as a CRC screening method, single-vial FIT screening is recommended by Polymedco, the National Cancer Institute, and the VHA. independently assessed risk of bias, inconsistency, indirectness, imprecision, and publication bias. As patients with an abnormal result are at greater risk for precancerous polyps or cancer, it is important to attend to follow-up procedures. We conducted a systematic review and meta-analysis to explore the diagnostic accuracy of FIT for CRC or advanced neoplasia (AN) in asymptomatic individuals with a familial or personal history of CRC. et al. We deemed all 4 studies employing qualitative FITs28,30,32,37 and all 3 studies using delayed colonoscopy as a reference standard26,34,37 as high risk. Colonoscopy is currently the only recommended screening modality for participants at increased risk of CRC owing to personal or family history. The study points to the importance of more closely monitoring people who do not follow recommendations after a positive FIT result, said Erica Breslau, Ph.D., M.P.H., of NCIs Healthcare Delivery Research Program, who also was not involved in the study. Critical revision of the manuscript for important intellectual content: All authors. We explored the robustness of our results in a post hoc sensitivity analysis including only studies in patients with family history of CRC that used quantitative FIT with a cut-off value of less than 25 g Hb/g feces. Studies have shown that this type of test detects cancer with 92 percent accuracy. Reasons for participation and nonparticipation in colorectal cancer screening: a randomized trial of colonoscopy and CT colonography. If you get a positive Cologuard result, it means the test detected signs of colon cancer or precancerous polyps. No bowel prep. By contrast, in the no-colonoscopy group, new cases went up more gradually but continued rising over 10 years. Positive and negative predictive values were 43.8% and 94.0%, respectively. Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk for Colorectal Cancer: A Meta-analysis. In Italy, unlike in the United States, all citizens are entitled to care that is mostly free through Italys National Health Service. This test examines DNA in your stool for evidence of cells shed by colorectal cancer. Given the safety, simplicity, low cost, and minimal discomfort of FIT, it is a viable alternative screening strategy for patients at increased risk for CRC. Brozek . . These data therefore are providing additional evidence supporting the adoption of a 2-year interval for FIT screening, wrote Senore and Zorzi. Diagnostic yield of the immunochemical fecal occult blood test in asymptomatic first degree relatives of colorectal cancer patients. In this systematic review and meta-analysis, we found reasonable diagnostic accuracy of FIT for CRC (AUC, 0.93) and AN (AUC, 0.86) in individuals with either a personal or family history of CRC. Of those, about 1.2% have a positive fit test result. RJ, Bossuyt The area under the ROC (AUC) for diagnosis of CRC and AN was 0.93 (95% CI, 0.90-0.95) and 0.86 (95% CI, 0.83-0.89), respectively (eFigure 4 in the Supplement). Bowel cancer (colorectal cancer, CRC) is the second most common cause of cancer death in the UK, accounting for 10% of all cancer deaths in 2017. M, Fendrick It is a noninvasive, private way to check for colon cancer without having to leave your house. Finally, we explored the clinical utility of FIT for patients at increased risk of CRC by means of Fagan nomogram. This test uses antibodies that specifically react with a blood protein in the stool. Having bowel cancer screening reduces your risk of dying from bowel cancer by at least 25% [footnote 1]. Less than 1 percent of these (601 cases) were advanced cancers. D, Liberati CLN Stat All Rights Reserved. Acquisition, analysis, or interpretation of data: All authors. FIT stands for fecal immunochemical test. The Bayesian estimate from the positive test result is almost seven times the assumed 0.7% prevalence. Who should be screened for colon cancer? AZ, Quintero Finally, 3 studies were prone to differential verification bias as they invited participants with negative FIT results to undergo a delayed colonoscopy as the reference standard.26,34,37 Most analyses had high heterogeneity and wide confidence intervals of pooled estimates, hence raising concerns about the reliability of our findings. JJ, Altman A, Bujanda Guidelines for average-risk populations support use of several screening modalities, including colonoscopy, fecal occult blood tests or computed tomography colonography. SJ, Grading quality of evidence and strength of recommendations in clinical practice guidelines: part 3 of 3. the GRADE approach to developing recommendations. Findings come from a study that is part of a larger effort to address screening disparities. As the broader DG30 criteria create a potentially enormous pool of low-risk patients, triage with FIT may lead to an overall increase in patients with false-positive . An abnormal . Collectively, two studies found that FIT performs poorly in identifying early-stage CRC but serves some benefit as a periodic screening tool. In a study from the Netherlands, 4523 people (age range, 50-74) underwent FIT screening with OC-Sensor Micro; a hemoglobin concentration of 50 ng/mL was considered positive. Respective values for diagnosing AN ranged from 0.29 to 0.83 (median, 0.50) and from 0.85 to 0.98 (median, 0.92). Data Extraction and Synthesis The test, known as the fecal immunochemical test (FIT), checks for traces of blood in patient-collected stool samples, which can be an early sign of cancer. L, AS, Rutjes The DNA test is 92% effective at detecting cancers. The low incidence of colorectal cancer after that was likely due to the early detection of cancers and the removal of precancerous lesions during colonoscopy, Dr. Breslau explained. The study included 111,423 people who had a positive FIT test, of whom 88,013 people had a follow-up colonoscopy as part of the program (colonoscopy group) and 23,410 did not (no-colonoscopy group). Dominitz Fecal Immunochemical Test (FIT) and Stool DNA (Cologuard). However, the robustness of our results was verified in a series of subgroup analyses. The average sensitivity of FIT for CRC was 93% (95% CI, 53%-99%), and the average specificity was 91% (95% CI, 89%-92%), yielding a positive likelihood ratio (LR+) of 10.30 (CI 7.7-13.9) and a negative likelihood ratio (LR) of 0.08 (95% CI, 0.01-0.75) (GRADE: very low). . Beyond diagnostic accuracy: the clinical utility of diagnostic tests. P, Hazazi Individuals at average risk are screened using the fecal immunochemical test (FIT), which has been available in British Columbia for the past 5 years CM, Gatsonis CA. As with the gFOBT, you perform at home with no bowel prep. US Department of Health & Human Services Agency for Healthcare Research and Quality. Testing for fecal occult blood is commonly used as a cancer screen for colon cancer. In the study, 3 percent of the people with positive FIT results were diagnosed with colorectal cancer (2,191 total cases). The pooled sensitivity was approximately 93% for CRC but much lower for AN (48%). On the other hand, the posttest probability for CRC or AN following a negative result of FIT is 0% or 6.0% respectively (eFigure 7 in the Supplement). These findings confirm the results of previous reports that showed that early stage CRCs and advanced adenomas are less likely to bleed than advanced-stage CRCs, as well as studies that reported that FIT sensitivity (especially for early-stage CRC or advanced adenomas) decreases with higher cutoff levels, they summarized. 900 Seventh Street, NW Suite 400 MR, Seaman The methodological quality assessment of the included studies is summarized in eFigures 2 and 3 in the Supplement. Hunt A search of MEDLINE, EMBASE, the Cochrane Library, and gray literature sources identified 3026 records. 20 participants of the 47 who had polyps had advanced adenomas . LA, FIT (Fecal Immunochemical Test) is a stool test used to look for possible signs of colorectal cancer. Gopalakrishna Experts generally recommend that people repeat this test every 1 to 2 years. We also conducted a sensitivity analysis including data only from patients with family history of CRC. M, Sensitivity 98%; . To fully evaluate FIT sensitivity and effectiveness, a longitudinal study should assess its performance over several rounds of testing, taking into account the stage and site distribution of screen-detected CRCs and [interval CRCs] ICs in each round, they suggested. Data Sources KG. This randomized clinical trial compares the effect of a single oral dose of aspirin vs placebo prior to fecal immunochemical testing (FIT) on test sensitivity for detecting advanced colorectal neoplasms. In the United States, cancer screening is a complex process that involves multiple steps and can be affected by many factors, Dr. Breslau said. A follow-up, or diagnostic, colonoscopy can find not only colorectal cancer but also precancerous growths, or polyps, that doctors can remove during the procedure, reducing the risk of future cancers. Thus, our results suggest that in increased-risk individuals FIT has high diagnostic accuracy for CRC. et al; Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. Despite the use of an exhaustive and meticulous search strategy, we could only find 12 eligible studies. TR, de Haan R, Rozen This study shows that even with a national health service that provides universal coverage, there are other barriers to obtaining care, Dr. Breslau said. For example, peoples fears about the preparation for colonoscopy continue to be a major barrier. Hierarchical models were used to synthesize available evidence. CY. Lin The positivity rate was 8.4%. Subgroup analyses indicated that FIT cutoff values between 15- and 25-g/g feces provided the best combination of sensitivity and specificity for the diagnosis of CRC (93% and 94%, respectively). Higgins Over that time, about 2 percent of the people, about 2,700 of them, had positive tests. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. F, Amani The rate increased with age, but the rates found at all ages are much lower than rates of cancer in people undergoing screening colonoscopy without a prior FIT, lead authors George F. Longstreth, MD, and Daniel S. Anderson, MD, FACP, of Kaiser Permanente, Southern California, San Diego, told CLN Stat in a statement. Quiz Ref IDUse of cutoff values between 15 to 25 g Hb/g feces had the best combination of sensitivity and specificity for the diagnosis of CRC (93% and 94%, respectively), as well as the highest LR+ (15.1) and lowest LR (0.07). Assuming a pretest probability of 0.8% for CRC and 10.2% for AN (median prevalence in 7 and 12 studies included in the present meta-analysis, respectively), a positive result increases the probability of CRC to 8.0% and probability of AN to 42.0%. DA. Bossuyt Can have false-positive test results. Methodological quality of included studies graph: review authors' judgments about each item presented as percentages across all included studies, eFigure 4. Offering colonoscopy to participants with a negative fit and a first degree relative with CRC increases the detection of advanced neoplasia in a screening program. The Cologuard test has a 13% false-positive rate, which means 1 in 10 positive tests will incorrectly identify cancer or polyps. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. However, the validity of our conclusions is undermined by low or very low quality of the body of evidence. The American Cancer Society estimates more than 153,000 Americans will be diagnosed with colorectal cancer this year making it one of the most common cancers in both men and women. Medicines and foods do not interfere with the test. MEDLINE, EMBASE, Cochrane Library, and gray literature sources through August 2016. Diagnostic studies evaluating the accuracy of FIT for CRC or AN in patients with a personal or familial history of CRC using colonoscopy as the reference standard. Importance But the program in northeast Italy, which started in 2002, has maintained colonoscopy rates of 80% at just 3 months after a positive test result, they noted. Colonoscopy is a good test for finding polyps or cancer in the bowel. This review was based on a prespecified protocol registered with PROSPERO 2016 (CRD42016037924) and is reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.12. On average, the review found that FITs catch about 79 percent of colon cancers, and their specificity consistently tops 90 percent . Fraser A higher detection rate for colorectal cancer and advanced adenomatous polyp for screening with immunochemical fecal occult blood test than guaiac fecal occult blood test, despite lower compliance rate. van Rossum The sensitivity was overall lower in individuals with a family history of CRC compared with a personal history. Rutter Pinnacle Biolabs' Second Generation FIT offers results in minutes, and it is reportedly the top-selling colon cancer screening test in North America. Apparently false-positive FIT results were found for 378 participants (8.1%). U.S. 2022 American Association for Clinical Chemistry. Question FIT has high overall diagnostic accuracy for CRC in increased-risk individuals. Fecal immunochemical test (FIT). Fecal immunochemical test (FIT) or immunochemical FOBT. The accuracy for advanced neoplasia however is moderate, and so further study of annual FIT to assess increased performance is warranted. You can change these settings at any time, but that may impair functionality on our websites. We assessed the full text of the remaining 202 reports. So it tends to be more accurate and have fewer false positive results than other tests. It has recently been suggested that fecal immunochemical testing (FIT) could be used for population-based screening owing to its high accuracy and adherence.7-9 Previous systematic reviews and meta-analyses have assessed the performance of FIT in average-risk populations.10,11 However, the potential role of FIT for screening of individuals at increased risk for CRC has not yet been fully elucidated. According to editorialists Senore and Zorzi, the study sheds new light on the tests sensitivity with respect to tumor characteristics. AACC uses cookies to ensure the best website experience. Systematic Review Data Repository. How To Categorize Accounting Fees In Quickbooks , What Happened To Marcelo , Division Symbol Vs Slash , List Of High Risk Activities Air Force , Classical Guitar Luthiers Colorado , Chiong Sisters Conspiracy , Aerial Lineman Salary California , Johnny Jett Father Age , Batman Stunt Show Six . C, A negative Cologuard test means that the home test did not detect significant levels of DNA and/or hemoglobin biomarkers in the stool that are associated with colorectal cancer. Having a stool DNA test may lead to additional testing. keeping a . Synopsis of Results From Subgroup Analyses Depending on Cutoff Value, Type of FIT and Number of FIT Samples Used for the Diagnosis of Colorectal Cancer or Advanced Neoplasia. A periodic FIT, however, might have some benefit in individuals with average CRC risk. We excluded studies with symptomatic patients or patients with inflammatory bowel disease, hereditary nonpolyposis colorectal cancer, familial adenomatous polyposis, or studies for which 22 diagnostic tables could not be inferred. Conflict of Interest Disclosures: None reported. Six studies were deemed at high risk of bias,26,28,30,32,34,37 1 study at unclear risk,36 and 5 studies at low risk of bias.27,29,31,33,35, All but 1 study reported use of consecutive or random sampling.30 FIT was used prior to the reference standard in 11 studies, and only 1 study did not provide relevant data.36 All studies used prespecified FIT thresholds. May 5, 2022 , by Elia Ben-Ari. Screening for colorectal cancer, the second leading cause of cancer-related deaths in the United States and other high-income countries, has been shown to reduce deaths from this disease. Whiting Oort However, most studies had a small sample size or low prevalence of CRC or AN, limiting the precision of effect estimates. It is thus imperative for future studies to include larger and better-defined patient populations. Understanding why some people are willing to be screened but do not follow up can lead to improvements in the effectiveness of the screening process.. et al. Medicines and food do not interfere with the test. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false-positive (FP) results adding to colonoscopy burden without improving cancer detection. This delayed diagnosis likely explains the higher death rate from colorectal cancer in this group, Dr. Breslau said. GRADE handbook for grading quality of evidence and strength of recommendations. It's also possible for the test to miss some cancers, which is called a false-negative result. How Fit Is FIT for Detecting Colorectal Cancer? On the other hand, our results also show that FIT could diagnose only half of the cases with AN. We included 12 studies (6204 participants). But because you use FIT every year, 10 . N Engl J Med 1999;341:38-46 addresses some questions you might have if you turned out to have a positive test. van Rossum B, 51% will have a precancerous polyp. Finally, we could not calculate the pooled estimates in a sensitivity analysis including only studies at low risk of bias in patients with family history of CRC that used immediate colonoscopy due to limited data. The FIT identified patients with CRC with overall high sensitivity but missed nearly 50% of small (T1) and 32% of UICC stage I CRCs. Study selection methods. P, Leshno Annual fecal immunochemical testing (FIT) is cost-effective for colorectal cancer (CRC) screening. F, Agustin However, those who did not get a follow-up colonoscopy were about twice as likely to die of colorectal cancer over a 10-year period as those who did have a follow-up colonoscopy. AL, CR, Dr. Zorzis team found that people in the no-colonoscopy group were at higher risk of dying from all causes, not just from colorectal cancer. K, Grossman Just 0.7 per 1,000 subjects 50 to 59 years of age had cancer. MA, Levin Dwamena AW, Westwood Heterogeneity and small sample size limit the precision of the results. This study will investigate the use of digital rectal exam (DRE) to obtain stool samples for the fecal immunochemical test (FIT) in patients due for screening colonoscopy and in pre-operative patients with known colorectal cancer. Stool samples collected at home are sent in for analysis. A sample of the stool is placed in a tube or on a card and sent away to the doctor or laboratory for testing. What is the diagnostic accuracy of fecal immunochemical testing (FIT) for screening of colorectal cancer (CRC) or advanced neoplasia in asymptomatic high-risk populations? The FIT identified that there was blood in the stool. Our main analysis is based on data from 6204 participants. Fecal Immunochemical Test (FIT): common questions. Finally, we graded the quality of the body of evidence using appropriate methodology (GRADE). and percentage of males ranged from 30.2 to 50.6%. It is a very sensitive test, and that polyps, hemorrhoids (both internal and external), and ulcers can all cause a positive fit test. JL, Akl The FIT test, or fecal immunochemical blood test, is a newer and more accurate way to test for blood in stool, which can be a symptom of colon cancer. Not a virtual colonoscopy, or another stool test, or another scan of some sortyou need a real optical colonoscopy. It is also important to establish optimal thresholds, test cutoff values, and number and frequency of FIT samples.10 Our results also should prompt randomized trials to assess the implementation of FIT either alone or in combination with other screening procedures into screening strategies for increased-risk individuals. The last search was performed in August 2016 (eFigure 1 in the Supplement). Statistical analysis: Katsoula, Paschos, Haidich, Tsapas. Sensitivity was particularly low for T1 and stage I cancers in the distal colon (32% and 52%, respectively) although generally very high for cancers with higher T stage (T2-T4) and more advanced stage (UICC stage IIIV) overall. Because the fecal occult blood test (FOBT) was not as accurate, the fecal immunochemical test (FIT) was developed. Respective values for AN were sensitivity, 47% (95% CI, 37%-58%); specificity, 93% (95% CI, 91%-95%); LR+, 6.90 (95% CI, 4.90-9.70); and LR, 0.56 (95% CI, 0.46-0.69). M, Gimeno-Garcia AACC.org The program offers free FIT testing once every 2 years to people 5069 years old. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.