FIT-Based Screening Associated With Major CRC Mortality Decline
Key Clinical Summary
Organized FIT Screening Linked to Lower Colorectal Cancer Mortality
- Per JAMA Network Open (2026), a retrospective population-based cohort included approximately 2.2 million Basque Country, Spain, residents from 2004–2024; biennial single-sample FIT screening targeted asymptomatic adults aged 50–69 years beginning in 2009.
- Colorectal cancer mortality declined 50.1% among screening-eligible adults, from 39.7 to 19.8 deaths per 100,000; a significant trend change occurred in 2012 (P<.001).
- Participation remained approximately 70%, colonoscopy adherence exceeded 91%, and 70.8% of 4,892 screen-detected cancers were stage I–II; the observational design supports association, not causation.
An organized fecal immunochemical test (FIT)–based colorectal cancer (CRC) screening program was associated with a sustained reduction in CRC mortality over 21 years, including a 50.1% decline among adults aged 50 to 69 years, according to a population-based cohort study in the Basque Country of Spain.
The investigators conducted a retrospective study encompassing approximately 2.2 million residents from 2004 through 2024. The organized screening program was initiated in 2009 and offered asymptomatic adults aged 50 to 69 years a single-sample FIT every 2 years. Individuals younger than 50 years served as a nonscreening reference group. Researchers evaluated age-standardized CRC mortality rates (ASMRs), temporal mortality trends, screening participation, FIT positivity, colonoscopy adherence, CRC detection, and stage distribution.
Among 438,134 all-cause deaths during the study period, 16,298 (3.7%) were attributed to CRC. Overall CRC mortality declined 29.6%, from 32.8 deaths per 100,000 population in 2004 to 23.1 per 100,000 in 2024 (P=.002). The largest reduction occurred among screening-eligible adults aged 50 to 69 years, whose CRC mortality decreased 50.1%, from 39.7 to 19.8 deaths per 100,000 population. No significant mortality change was observed among individuals younger than 50 years.
Segmented regression identified a significant change in mortality trends in 2012, approximately 3 years after screening began (P<.001). Among adults aged 50 to 69 years, counterfactual modeling projected a 2024 ASMR of 36.8 deaths per 100,000 without the observed change in trend, compared with an actual rate of 19.8—a relative difference of 46.2%.
Screening participation remained approximately 70% over the study period, while adherence to follow-up colonoscopy after a positive FIT exceeded 91%. Among 4892 screen-detected CRCs with staging information, 3464 (70.8%) were diagnosed at stage I or II.
“In this retrospective, population-based, descriptive cohort study, organized FIT-based screening was associated with a sustained decline in CRC mortality, particularly among individuals aged 50 to 69 years,” the study authors concluded. “These findings support the long-term benefit of organized FIT-based screening programs as a public health strategy to reduce CRC-related mortality.”
Reference
Bujanda L, Val B, Portillo Villares I, et al. Colorectal cancer mortality following an organized fecal immunochemical test–based screening program. JAMA Netw Open. 2026;9(8):e2626951. doi:10.1001/jamanetworkopen.2026.26951.
