title: Reduced and Full-Preparation CT Colonography, Fecal Immunochemical Test, and Colonoscopy for Population Screening of Colorectal Cancer: A Randomized Trial.
abstract: BACKGROUND
  Population screening for colorectal cancer (CRC) is widely adopted, but the preferred strategy is still under debate. We aimed to compare reduced (r-CTC) and full cathartic preparation CT colonography (f-CTC), fecal immunochemical test (FIT), and optical colonoscopy (OC) as primary screening tests for CRC.
  
  
  METHODS
  Citizens of a district of Florence, Italy, age 54 to 65 years, were allocated (8:2.5:2.5:1) with simple randomization to be invited by mail to one of four screening interventions: 1) biennial FIT for three rounds, 2) r-CTC, 3) f-CTC, 4) OC. Patients tested positive to FIT or CTC (at least one polyp ≥6mm) were referred to OC work-up. The primary outcomes were participation rate and detection rate (DR) for cancer or advanced adenoma (advanced neoplasia). All statistical tests were two-sided.
  
  
  RESULTS
  Sixteen thousand eighty-seven randomly assigned subjects were invited to the assigned screening test. Participation rates were 50.4% (4677/9288) for first-round FIT, 28.1% (674/2395) for r-CTC, 25.2% (612/2430) for f-CTC, and 14.8% (153/1036) for OC. All differences between groups were statistically significant (P = .047 for r-CTC vs f-CTC; P < .001 for all others). DRs for advanced neoplasia were 1.7% (79/4677) for first-round FIT, 5.5% (37/674) for r-CTC, 4.9% (30/612) for f-CTC, and 7.2% (11/153) for OC. Differences in DR between CTC groups and FIT were statistically significant (P < .001), but not between r-CTC and f-CTC (P = .65).
  
  
  CONCLUSIONS
  Reduced preparation increases participation in CTC. Lower attendance and higher DR of CTC as compared with FIT are key factors for the optimization of its role in population screening of CRC.
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD). lapo.sali@unifi.it.
authors.forename: Lapo
authors.initials: L
authors.lastname: Sali
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Mario
authors.initials: M
authors.lastname: Mascalchi
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Massimo
authors.initials: M
authors.lastname: Falchini
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ventura
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Francesca
authors.initials: F
authors.lastname: Carozzi
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Guido
authors.initials: G
authors.lastname: Castiglione
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Silvia
authors.initials: S
authors.lastname: Delsanto
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mallardi
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Paola
authors.initials: P
authors.lastname: Mantellini
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Stefano
authors.initials: S
authors.lastname: Milani
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.affiliation: Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy (LS, MM, MF, SM); Cancer Prevention and Research Institute (ISPO), Florence, Italy (LV, FC, GC, BM, PM, MZ, GG); im3D S.p.A., Turin, Italy (SD).
authors.forename: Grazia
authors.initials: G
authors.lastname: Grazzini
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D002400:Cathartics / Q000008:administration & dosage; D023881:Colonography, Computed Tomographic / Q000379:methods / Q000706:statistics & numerical data; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D055088:Early Detection of Cancer / Q000379:methods; D007558:Italy; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods; D009780:Occult Blood; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data
chemical_list: D002400:Cathartics