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Am Fam Physician. 2023;107(2):134-135

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

Are fecal immunochemical tests (FITs) superior to guaiac-based fecal occult blood tests (gFOBTs) when screening individuals at average risk for colorectal cancer?

Evidence-Based Answer

FITs are more likely than gFOBTs to detect colorectal cancer or advanced adenomas in individuals at average risk.1 (Strength of Recommendation = A, consistent, good-quality patient-oriented evidence.)

Practice Pointers

In 2019, colorectal cancer was the fourth most common cancer in the United States and was the fourth highest cause of cancer-related mortality.2 Screening with a gFOBT or FIT can find colorectal cancer during the presymptomatic phase or detect advanced adenomas, potential precursors to colorectal cancer. Early identification leads to easier treatments and lower mortality.1 The authors of the review sought to compare the accuracy of gFOBTs vs. FITs for population-based screening for colorectal cancer and advanced adenomas in individuals at average risk.

The Cochrane review included 63 high-quality studies and more than 3.7 million patients older than 40 years.1 The included studies used a variety of methodologies, controls, and comparisons, which led the authors to analyze them using two primary constructs. Studies in which participants received both a fecal test and a colonoscopy were termed reference standard: all. Studies that used a sequential screening method in which only a positive fecal screening was followed by colonoscopy were termed reference standard: positive. The authors only included studies that used colonoscopy as the reference standard.

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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