There are several different methods available to screen for CRC, including colonoscopy and fecal immunochemical testing, or FIT. Colonoscopy involves threading a small camera into the colon to look for abnormal lesions (called adenomas) or malignant tumors, which can be removed at the time of the procedure. FIT checks a stool sample for the presence of blood, a possible indicator of adenomas or tumors. If blood is detected, patients are referred for a colonoscopy.
Researchers used two microsimulation models to measure the effectiveness of the two CRC tests. Both models simulated the low-income, uninsured population of South Carolina, a state that offers a free CRC screening program. Within each model, the researchers assessed whether colonoscopy or FIT would be most effective given a modest budget of $1 million.
Although colonoscopy finds more precancerous adenomas and cancers in a single screening, it costs significantly more than FIT. For example, Medicare reimbursement is between $650 and $830 for the average colonoscopy, compared to about $22 for FIT. The researchers found that an annual FIT screening program could screen nearly eight times as many individuals and prevent nearly twice as many CRC cases as a colonoscopy program could. A FIT program would also save about four times as many lives.