Gong Changlin, Rojas Maria Teresa Medina, Guerrero Maria Gabriela Rubianes, Kladas Michail, Mousakhanian Arameh, Sudan Aarushi, Johnson Adejoke, Cartmill Kimberly, Sydney Elana, Kotler Donald P
Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Internal Medicine, Metropolitan Hospital/New York Medical College, New York, NY, USA.
J Gastrointest Cancer. 2025 Feb 22;56(1):69. doi: 10.1007/s12029-025-01187-y.
The fecal immunochemical test (FIT) is highly effective in reducing colorectal cancer (CRC) mortality, but patient adherence to the screening process remains questionable. We present preliminary findings from a quality improvement (QI) initiative, in order to assess screening adherence and findings.
All FIT specimens in a 30-month period were retrospectively examined. Patients with positive results were included, and information was collected via electronic medical record, including QI measures such as colonoscopy completion and findings. All data were de-identified. Patients were divided into "asymptomatic group" and "symptomatic group" based on clinical manifestations. Adherence and findings were analyzed.
FIT results were positive in 174 out of 2400 specimens. Colonoscopy was performed in 47.6% of all FIT-positive cases after a median interval of 5.5 (interquartile range, IQR 3-10) months, with 10% having CRC, 51.3% having adenomas, and 17.5% having advanced adenomas. Of all nine patients who had CRC, seven were in the symptomatic group. All five advanced cancers were found in the symptomatic group. Patients who actually completed colonoscopy were significantly younger than those who did not (median 61.5 years, IQR 56.5-69 years, vs. 64.5 years, IQR 59-71 years, P = 0.048). Patient-related reasons, primarily refusal, accounted for 65.9% of unperformed colonoscopies. No significant difference was found in adherence and yield between asymptomatic and symptomatic groups.
Prevalence of colorectal adenomas and cancers is high in FIT-positive patients. A substantial number of CRCs and potentially preventable CRCs must have been missed because of low adherence rate, especially in older patients. Improving adherence to CRC screening in public hospitals requires enhanced patient engagement.
粪便免疫化学检测（FIT）在降低结直肠癌（CRC）死亡率方面非常有效，但患者对筛查过程的依从性仍存在疑问。我们展示了一项质量改进（QI）计划的初步结果，以评估筛查依从性和检查结果。
回顾性检查了30个月内的所有FIT样本。纳入结果呈阳性的患者，并通过电子病历收集信息，包括结肠镜检查完成情况和检查结果等QI指标。所有数据均进行了去识别处理。根据临床表现将患者分为“无症状组”和“有症状组”。分析依从性和检查结果。
2400份样本中有174份FIT结果呈阳性。在所有FIT阳性病例中，47.6%在中位间隔5.5（四分位间距，IQR 3 - 10）个月后进行了结肠镜检查，其中10%患有CRC，51.3%患有腺瘤，17.5%患有高级别腺瘤。在所有9例患有CRC的患者中，7例在有症状组。所有5例进展期癌症均在有症状组中发现。实际完成结肠镜检查的患者明显比未完成的患者年轻（中位年龄61.5岁，IQR 56.5 - 69岁，对比64.5岁，IQR 59 - 71岁，P = 0.048）。与患者相关的原因，主要是拒绝，占未进行结肠镜检查的65.9%。无症状组和有症状组在依从性和检出率方面未发现显著差异。
FIT阳性患者中结直肠腺瘤和癌症的患病率较高。由于依从率低，大量的CRC和潜在可预防的CRC肯定被漏诊了，尤其是在老年患者中。提高公立医院CRC筛查的依从性需要加强患者参与度。
