Significance of Faecal Immunochemical Testing (FIT) in early detection of adenomatous colorectal cancer (CRC) - Survival and Staging in Malta

Problem

Adenomatous Colorectal cancer(CRC) patient data between 2008-2011 was compared with patients flagged with Faecal Immunochemical Testing (FIT) and eventually diagnosed with CRC in the Maltese Islands, specifically overall survival and staging. FIT staging was introduced in Malta in 2013 and this study focused on patients diagnosed till 2018.

Approach

Data of patients identified with CRC after positive FIT Testing was given by Malta National Screening, a department under the care of Primary Health Malta. The necessary histopathology reports were primarily obtained from the main hospital intranet through iSoft’s iClinical Manager (iCM) and physical files. Microsoft Excel and IBM SPSS statistics were used to compile the data obtained from such reports, compare and test for statistical significance. Results were done compared to data collected in 2008 and 2012 of patients diagnosed prior to FIT testing.

Findings

From 81,019 tests analysed between 2013 and 2018, 4,066 positive tests were obtained which led to 3,701 patients undergoing colonoscopies. 144 cases of CRC were diagnosed and elected for this study. Results have shown that the majority of these patients were diagnosed early with better survival compared with patients diagnosed before 2012, prior to FIT testing. The study also showed that Right CRC might be missed due to reduced rates of right CRC across all years. Right CRC patients have also been diagnosed at later stages with worse survival rates compared to left CRC patients

Consequences

FIT testing leads to early diagnosis which in turn improves survival and prognosis. However, further analysis on efficacy compared with gold standard colonoscopy needs to be done due to suspected missed right CRC cases.