The Impact of Age on Preferences for Colorectal Cancer Surveillance Strategies: Are Fecal Immunochemical Tests FIT for Surveillance?

Publisher: John Wiley & Sons Ltd Country of Publication: United States NLM ID: 101595310 Publication Model: Print Cited Medium: Internet ISSN: 2045-7634 (Electronic) Linking ISSN: 20457634 NLM ISO Abbreviation: Cancer Med Subsets: MEDLINE

Original Publication: [Malden, MA] : John Wiley & Sons Ltd., c2012-

Colorectal Neoplasms*/diagnosis ; Colorectal Neoplasms*/epidemiology ; Colonoscopy*/statistics & numerical data ; Patient Preference* ; Early Detection of Cancer*/methods ; Occult Blood*; Humans ; Female ; Male ; Middle Aged ; Adult ; Aged ; Age Factors ; Surveys and Questionnaires ; Population Surveillance ; Feces/chemistry ; Immunochemistry

Introduction: Individuals with a known risk of colorectal cancer (CRC) are recommended regular surveillance colonoscopies. Alternative surveillance strategies incorporating fecal immunochemical tests (FIT) may improve colonoscopy resource utilization and be more appropriate for those with a lower risk of CRC, particularly younger adults. This study compared younger (< 50 years) and older (≥ 50 years) adults' preferences for different CRC surveillance strategies.
Methods: Eight hundred individuals enrolled in a colonoscopy-based surveillance program were invited to complete a survey assessing CRC surveillance preferences. Preferences for colonoscopy frequency and the acceptability of two alternative protocols were assessed: (1) providing FIT between colonoscopies, and (2) a FIT-only strategy where colonoscopy would only be required after a positive FIT result.
Results: A total of 102 younger (median age 41.4 years, 67.6% female) and 187 older (median age 68.5 years, 49.2% female) adults completed the survey. Surveillance preferences did not significantly vary by age group; most respondents preferred colonoscopies more often than their current frequency (< 50 years: 54.1%; ≥ 50 years: 58.1%). Although most participants (< 50 years: 91.2%; ≥ 50 years: 93.0%) agreed that FIT is important to complete between surveillance colonoscopies, only a small proportion were comfortable with FIT-only surveillance replacing colonoscopies (< 50 years: 27.5%; ≥ 50 years: 37.4%). Fear of CRC was a significant predictor of preferences for more frequent surveillance incorporating FIT in younger, but not older, adults.
Conclusion: Many individuals with an elevated risk of CRC wanted more frequent surveillance, regardless of their age. Extending surveillance colonoscopy intervals using FIT may be a more acceptable method of reducing colonoscopy frequency rather than utilizing a FIT-only approach.
Trial Registration: This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN #12619001743156).
(© 2025 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

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N/A Flinders University; 2009050 National Health and Medical Research Council; APP1160443 National Health and Medical Research Council

Keywords: colonoscopy; colorectal neoplasms; early detection of cancer; fecal occult blood test; patient preference; population surveillance

Date Created: 20250303 Date Completed: 20250303 Latest Revision: 20250305

20250305

PMC11873988

10.1002/cam4.70723

40029035