title: Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening.
abstract: BACKGROUND
  Colonoscopy and fecal immunochemical testing (FIT) are accepted strategies for colorectal-cancer screening in the average-risk population.
  
  
  METHODS
  In this randomized, controlled trial involving asymptomatic adults 50 to 69 years of age, we compared one-time colonoscopy in 26,703 subjects with FIT every 2 years in 26,599 subjects. The primary outcome was the rate of death from colorectal cancer at 10 years. This interim report describes rates of participation, diagnostic findings, and occurrence of major complications at completion of the baseline screening. Study outcomes were analyzed in both intention-to-screen and as-screened populations.
  
  
  RESULTS
  The rate of participation was higher in the FIT group than in the colonoscopy group (34.2% vs. 24.6%, P<0.001). Colorectal cancer was found in 30 subjects (0.1%) in the colonoscopy group and 33 subjects (0.1%) in the FIT group (odds ratio, 0.99; 95% confidence interval [CI], 0.61 to 1.64; P=0.99). Advanced adenomas were detected in 514 subjects (1.9%) in the colonoscopy group and 231 subjects (0.9%) in the FIT group (odds ratio, 2.30; 95% CI, 1.97 to 2.69; P<0.001), and nonadvanced adenomas were detected in 1109 subjects (4.2%) in the colonoscopy group and 119 subjects (0.4%) in the FIT group (odds ratio, 9.80; 95% CI, 8.10 to 11.85; P<0.001).
  
  
  CONCLUSIONS
  Subjects in the FIT group were more likely to participate in screening than were those in the colonoscopy group. On the baseline screening examination, the numbers of subjects in whom colorectal cancer was detected were similar in the two study groups, but more adenomas were identified in the colonoscopy group. (Funded by Instituto de Salud Carlos III and others; ClinicalTrials.gov number, NCT00906997.).
authors.affiliation: Department of Gastroenterology, Hospital Universitario de Canarias, Tenerife, Spain. equinter@gmail.com
authors.forename: Enrique
authors.initials: E
authors.lastname: Quintero
authors.forename: Antoni
authors.initials: A
authors.lastname: Castells
authors.forename: Luis
authors.initials: L
authors.lastname: Bujanda
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cubiella
authors.forename: Dolores
authors.initials: D
authors.lastname: Salas
authors.forename: Ángel
authors.initials: Á
authors.lastname: Lanas
authors.forename: Montserrat
authors.initials: M
authors.lastname: Andreu
authors.forename: Fernando
authors.initials: F
authors.lastname: Carballo
authors.forename: Juan Diego
authors.initials: JD
authors.lastname: Morillas
authors.forename: Cristina
authors.initials: C
authors.lastname: Hernández
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jover
authors.forename: Isabel
authors.initials: I
authors.lastname: Montalvo
authors.forename: Juan
authors.initials: J
authors.lastname: Arenas
authors.forename: Eva
authors.initials: E
authors.lastname: Laredo
authors.forename: Vicent
authors.initials: V
authors.lastname: Hernández
authors.forename: Felipe
authors.initials: F
authors.lastname: Iglesias
authors.forename: Estela
authors.initials: E
authors.lastname: Cid
authors.forename: Raquel
authors.initials: R
authors.lastname: Zubizarreta
authors.forename: Teresa
authors.initials: T
authors.lastname: Sala
authors.forename: Marta
authors.initials: M
authors.lastname: Ponce
authors.forename: Mercedes
authors.initials: M
authors.lastname: Andrés
authors.forename: Gloria
authors.initials: G
authors.lastname: Teruel
authors.forename: Antonio
authors.initials: A
authors.lastname: Peris
authors.forename: María-Pilar
authors.initials: MP
authors.lastname: Roncales
authors.forename: Mónica
authors.initials: M
authors.lastname: Polo-Tomás
authors.forename: Xavier
authors.initials: X
authors.lastname: Bessa
authors.forename: Olga
authors.initials: O
authors.lastname: Ferrer-Armengou
authors.forename: Jaume
authors.initials: J
authors.lastname: Grau
authors.forename: Anna
authors.initials: A
authors.lastname: Serradesanferm
authors.forename: Akiko
authors.initials: A
authors.lastname: Ono
authors.forename: José
authors.initials: J
authors.lastname: Cruzado
authors.forename: Francisco
authors.initials: F
authors.lastname: Pérez-Riquelme
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Alonso-Abreu
authors.forename: Mariola
authors.initials: M
authors.lastname: de la Vega-Prieto
authors.forename: Juana Maria
authors.initials: JM
authors.lastname: Reyes-Melian
authors.forename: Guillermo
authors.initials: G
authors.lastname: Cacho
authors.forename: José
authors.initials: J
authors.lastname: Díaz-Tasende
authors.forename: Alberto
authors.initials: A
authors.lastname: Herreros-de-Tejada
authors.forename: Carmen
authors.initials: C
authors.lastname: Poves
authors.forename: Cecilio
authors.initials: C
authors.lastname: Santander
authors.forename: Andrés
authors.initials: A
authors.lastname: González-Navarro
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D003113:Colonoscopy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D012680:Sensitivity and Specificity