FIT Screening Participation Stabilizes After Initial Round, Meta-Analysis Finds
Clinical Practice Summary
Repeated FIT Screening Shows Stable Participation, Declining CRC Yield
-
A systematic review and meta-analysis of 24 studies evaluated long-term adherence and performance across organized FIT-based colorectal cancer screening rounds.
-
Overall, 47.1% consistently completed every round, 22.7% participated intermittently, and 30.3% never participated; per-round participation increased from 51.3% initially to 56.5% by round 4.
-
FIT positivity declined from 6.6% to 5.3%, CRC positive predictive value (PPV) from 5.8% to 2.5%, and advanced adenoma PPV from 32.8% to 23.0%; adenoma PPV remained 44.6%–48.7%. Yields may stabilize by rounds 3–4.
Nearly half of participants in organized fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening programs consistently completed every screening round, while approximately one-third never participated, according to a systematic review and meta-analysis examining long-term adherence and screening performance across multiple rounds.
Investigators reviewed 24 studies identified from PubMed, Embase, and the Cochrane databases to evaluate adherence patterns, participation rates, FIT positivity, and neoplasia detection in organized FIT-based CRC screening programs. Outcomes were compared between initial and subsequent screening rounds, with subgroup analyses based on screening interval and FIT positivity threshold.
Across the included studies, 47.1% of individuals were classified as consistent screeners, participating in every screening round. An additional 22.7% participated intermittently, while 30.3% never attended screening.
Participation remained relatively stable after the initial screening round. Per-round participation increased from 51.3% in the first round to 56.7%, 56.9%, and 56.5% in the second, third, and fourth rounds, respectively.
The yield of screening was highest during the initial round and declined thereafter. FIT positivity decreased from 6.6% in the first round to 5.6%, 5.3%, and 5.3% across subsequent rounds. Positive predictive values (PPVs) for CRC also declined from 5.8% in the first round to 3.3%, 2.9%, and 2.5% in later rounds.
Similarly, PPVs for advanced adenomas fell from 32.8% during the first round to 28.3%, 22.7%, and 23.0% in subsequent rounds. In contrast, adenoma detection remained relatively consistent, with PPVs ranging from 44.6% to 48.7% across all four screening rounds.
The observed trends were consistent among individuals who participated in every screening round and in analyses limited to biennial FIT programs using a 20 μg hemoglobin/g feces positivity threshold.
The authors concluded that “organized FIT-based CRC screening programs achieve consistent participation in nearly one-half of persons and no participation in approximately one-third.” They also reported that “FIT-positivity and yields for CRC, AA, and adenoma are highest in the first round and may stabilize at clinically relevant steady states at the third to fourth rounds.”
Reference
Baile-Maxía S, Pimienta M, Sánchez-Ardila C, Castells A, Jover R, Ladabaum U. Systematic review of participation, positivity, and yield over time in fecal immunochemical test-based organized colorectal cancer screening programs. Clin Gastroenterol Hepatol. 2026;24(8):2094-2107. doi:10.1016/j.cgh.2026.02.009
