Fit and Colonoscopy Uptake after the First Round of Testing in a Randomized Health Services Study Offering Competing Strategies for Colorectal Cancer Screening (Piccolino Study)

Aims Primary colonoscopy and fecal immunochemical testing (FIT) are considered first tier tests for colorectal cancer (CRC) screening. Although colonoscopy is considered the most efficacious test, FIT may achieve higher participation rates. We assessed diagnostic yield of FIT and colonoscopy after the first round of testing in the PICCOLINO study.

Methods This was a multicenter randomized health services study performed within the framework of the Polish Colonoscopy Screening Program (PCSP) between January 2019 and March 2020 on screening-naïve individuals. Eligible candidates were randomly assigned in a 1:1:1 ratio to participate in one of three competing invitation strategies: (I. control) invitation to screening colonoscopy only; (II. sequential) invitation to primary colonoscopy, and invitation for FIT for initial non-responders; or (III. choice) invitation offering a choice of colonoscopy or FIT. The primary outcome was participation in CRC screening within 18 weeks after enrollment into the study. The secondary outcome was diagnostic yield for advanced neoplasia (AN).

Results Overall, 12,452 individuals were randomized into three groups. The participation in the control group (17.5 %) was significantly lower compared to the sequential (25.8 %) and choice strategy (26.5 %) groups (p<0.001 for both comparisons). In the intention to screen analysis, AN detection rates were comparable between the control (1.1 %), sequential (1.0 %) and choice groups (1.1 %). In the intention to screen analysis, detection rates of all adenomas were the same in the control and in the sequential groups (5.6 %) and significantly lower in the choice group (3.9 %; p<0.001). Primary colonoscopy diagnosed 216 patients with adenomas in the control group, 200 patients in the sequential group, and 125 patients in the choice group. FIT contributed to diagnosis of 19 patients with adenomas in the sequential group and 32 patients with adenomas in the choice group.

Conclusions Increased participation in strategies with FIT do not translate into higher detection of AN or any adenoma.

Citation: Pilonis N, Bugajski M, Wieszczy P et al. OP36 FIT AND COLONOSCOPY UPTAKE AFTER THE FIRST ROUND OF TESTING IN A RANDOMIZED HEALTH SERVICES STUDY OFFERING COMPETING STRATEGIES FOR COLORECTAL CANCER SCREENING (PICCOLINO STUDY). Endoscopy 2021; 53: S18.

Publication History

Article published online:
19 March 2021