Feasibility and performance of the fecal immunochemical test (FIT) for average-risk colorectal cancer screening in Nigeria.

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  • Additional Information
    • Source:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • Publication Information:
      Original Publication: San Francisco, CA : Public Library of Science
    • Subject Terms:
      Early Detection of Cancer*; Colorectal Neoplasms/*diagnosis ; Feces/*chemistry; Adenoma/diagnosis ; Adenoma/pathology ; Aged ; Animals ; Colorectal Neoplasms/pathology ; Endoscopy ; Feasibility Studies ; Feces/parasitology ; Female ; Humans ; Immunochemistry ; Male ; Middle Aged ; Nigeria ; Parasites/physiology ; Risk Factors
    • Abstract:
      Introduction: There is a paucity of prospective data on the performance of the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening in sub-Saharan Africa. The aim of this exploratory analysis was to evaluate the feasibility and performance of FIT in Nigeria.
      Methods: This was a prospective, single-arm study. A convenience sample of asymptomatic, average-risk individuals between 40-75 years of age were enrolled at Obafemi Awolowo University Teaching Hospital. Study participants returned in 48 hours with a specimen for ova and parasite (O&P) and qualitative FIT (50ug/g) testing. Participants with a positive FIT had follow-up colonoscopy and those with intestinal parasites were provided treatment.
      Results: Between May-June 2019, 379 individuals enrolled with a median age of 51 years (IQR 46-58). In total, 87.6% (n = 332) returned for FIT testing. FIT positivity was 20.5% (95% CI = 16.3%-25.2%). Sixty-one (89.7%) of participants with a positive FIT had a follow-up colonoscopy (n = 61), of whom 9.8% (95%CI:3.7-20.2%) had an adenoma and 4.9% (95%CI:1.0-13.7%) had advanced adenomas. Presence of intestinal parasites was inversely related to FIT positivity (6.5% with vs. 21.1% without parasites, p = 0.05). Eighty-two percent of participants found the FIT easy to use and 100% would recommend the test to eligible family or friends if available.
      Conclusions: Asymptomatic, FIT-based CRC screening was feasible and well tolerated in this exploratory analysis. However, the high FIT positivity and low positive predictive value for advanced neoplasia raises concerns about its practicality and cost effectiveness in a low-resource setting such as Nigeria.
      Competing Interests: The authors have declared that no competing interests exist.
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    • Grant Information:
      P30 CA008748 United States CA NCI NIH HHS
    • Publication Date:
      Date Created: 20210112 Date Completed: 20210421 Latest Revision: 20210421
    • Publication Date:
      20240105
    • Accession Number:
      PMC7802943
    • Accession Number:
      10.1371/journal.pone.0243587
    • Accession Number:
      33434195