A longtime dilemma in preventive medicine – comparing the effectiveness of the two most commonly used colorectal cancer tracking strategies in the world – was tested in a major pragmatic, randomized and controlled clinical trial held in 15 tertiary hospitals from eight regions of Spain.
Called Colonprev, the study did not seek to prove that a method is better, but to demonstrate that the fecal immunochemical test (Fit) – which evaluates hidden blood in the stool – It is not clinically worse than colonoscopy, considered “gold standard” for colorectal cancer tracking.
Colonprev was coordinated by doctors Antoni Castells, Clinic Hospital de Barcelona, and Enrique Quintero, the University Hospital of Canary Islands. Held between June 1, 2009 and December 31, 2021, the rehearsal involved 57,404 invited individuals.
Robust and revolutionary, the work has confirmed the hypothesis of authors that laboratory feces -based programs work as well as complete colonoscopy -based programs to reduce colorectal cancer mortality, offering a more viable alternative.
The study figures showed very small differences in the risk of mortality in 10 years: colonoscopy had 0.22% risk (55 deaths), while FIT showed 0.24% (60 deaths). The difference of only 0.02% (5 more deaths) is considered “not inferior” because it is clinically insignificant.
Colonoscopy and hidden blood in the stool: main differences
Spanish study demonstrated significant differences in participation between screening methods. While 39.9% of participants sent fit kits by mail, only 31.8% attended scheduled colonoscopies. This disparity proves a global pattern of preference for the less invasive method.
The two screening methods have substantial differences in costs: while the home fit costs about $ 24 (R $ 130) according to the American Medicare, colonoscopies total US $ 635 (R $ 3,450) when including medical infrastructure costs.
Another point that drastically differentiates methods is convenience. Colonoscopy requires restrictive liquid diet, use of powerful laxatives, specialized transportation and post-procedure recovery time. More practical, the fit requires only minutes in the home bathroom and a prepaid envelope for shipping.
As for diagnostic efficiency, colonoscopy comes out as it offers an immediate therapeutic advantage. Positive fit results, in turn, trigger colonoscopies to complete the investigation.
Finally, the patient needs to choose between the advantage of the fit being exempt from side effects (even though it may need a posterior colonoscopy) Against the decision to have immediate resolution but accept minor risks, such as temporary swelling and even some (rare) serious complications.
What do the doctors say?
In the Brazilian context, which does not yet have an organized national tracking program, the results of the Colonprev study brought.
For Alexandre Carlos, coordinator of the Gastroenterology Diagnostic Center of the USP Hospital das Clínicas, “the hidden blood in the feces [SOF] It becomes an excellent initial alternative for medium -risk asymptomatic people, especially in resource limitation scenarios. “
In an interview with CNN Brazilthe intestinal inflammatory disease specialist explained that, because it is viable, cost-effective and scalable, the approach allows “the health system to rapidly expand population coverage, with less need for complex infrastructure as colonoscopy centers.”
In addition, the SOF test, being non -invasive, painless and easy to collect home, solves some of the main obstacles to colonoscopy, which include, according to Alexandre, “fear of examination, discomfort with intestinal preparation, need for anesthesia and time to leave work”.
However, it warns: “Colonoscopy is still recommended as a priority option in people with a family history of colorectal cancer, intestinal inflammatory diseases (such as ulcerative retailers or extended Crohn disease), hereditary syndromes (such as family polyposis or Lynch syndrome) or previous findings of advanced polyps.”
Asked about any changes in the national guidelines based on Colonprev, the expert recalled that, as the Sof is already offered today, as an alternative in many cases, change would be only national standardization. “From a clinical point of view, it is a quiet and welcome adaptation,” he concludes.
