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Offering people a choice for colorectal cancer screening
  1. Carlo Senore1,
  2. Andrea Ederle2,
  3. Luca Benazzato2,
  4. Arrigo Arrigoni3,
  5. Marco Silvani1,
  6. Alberto Fantin2,
  7. Mario Fracchia4,
  8. Paola Armaroli1,
  9. Nereo Segnan1
  1. 1Centro Prevenzione Oncologica Regione Piemonte and AOU S Giovanni Battista di Torino, Turin, Italy
  2. 2Gastroenterology Unit, Fracastoro Hospital, ULSS 20, Verona, Italy
  3. 3Gastroenterology Unit, S Giovanni AS Hospital, AOU S. Giovanni Battista di Torino, Turin, Italy
  4. 4Gastroenterology Unit, Mauriziano Umberto I Hospital, Turin, Italy
  1. Correspondence to Dr Carlo Senore, Centro Prevenzione Oncologica Regione Piemonte and Azienda Ospedaliero-Universitaria S Giovanni Battista di Torino, V San Francesco da Paola 31, 10123 Torino, Italy; carlo.senore{at}


Objectives To assess the population coverage and diagnostic yield of offering an immunochemical faecal occult blood test (FIT) to non-responders to a flexible sigmoidoscopy (FS) invitation.

Design A cohort study conducted in a population-based colorectal cancer (CRC) screening programme. In this programme, eligible men and women aged 58 (Turin; 43 748 subjects) or 60 (Verona; 19 970 subjects) are invited, with a personal letter signed by their general practitioner, to undergo an FS. Bowel preparation is limited to a single enema self-administered at home. Subjects in whom one distal polyp >5 mm (≥10 mm in Turin) or at least one adenoma (one advanced adenoma or more than two adenomas in Turin) is detected at FS are referred for colonoscopy. People who do not respond to the invitation to undergo an FS are invited to have an FIT (OC-Sensor; Eiken, Tokyo, Japan; single sample, cut-off 100 ng/ml). Attendance rate and neoplasia yield were analysed in four consecutive birth cohorts.

Results Overall participation rate for the FS invitation was 39.3% in Verona and 29.9% in Turin. Of the eligible non-responders to the FS invitation, 19.3% (95% CI 18.9% to 19.7%) underwent an FIT. As a result, the proportion of people undergoing screening by FS or FIT was 55.2% in Verona and 39.3% in Turin, with no gender differences in either centre. FIT detected 8.3% of all advanced adenomas and 20.4% of all CRCs diagnosed at screening.

Conclusions A strategy involving the sequential offer of FS and FIT is a feasible and efficient approach. FIT in people not attending for FS increases screening uptake and detection of advanced adenomas and CRCs.

  • Colorectal cancer
  • mass screening
  • faecal occult blood test (FIT)
  • flexible sigmoidoscopy (FS)
  • participation
  • cancer prevention
  • cancer epidemiology
  • colorectal neoplasia
  • meta-analysis
  • polyp
  • endoscopic ultrasonography
  • endoscopy
  • colorectal cancer screening
  • endoscopic polypectomy

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  • Funding This study was conducted in the context of the screening programme organised by the Regional Health Authority within the National Health Service.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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