Colonoscopy versus biennial FIT screening: a post hoc sustained-strategy analysis of the COLONPREV Trial
Menée en Espagne à partir de données portant sur 17 270 personnes âgées de 50 à 69 ans et ayant débuté un programme de dépistage du cancer colorectal, cette étude compare l'effet, sur l'incidence des cancers colorectaux, la mortalité liée à la maladie et la mortalité toutes causes confondues à 10 ans, d'une seule coloscopie et de stratégies de dépistage par test FIT biennal
Background : Pragmatic colorectal cancer (CRC) screening trials compare colonoscopy with faecal immunochemical testing (FIT), but differences in adherence complicate interpretation of comparative outcomes.
Objective : To compare 10-year risks of CRC mortality, CRC incidence and all-cause mortality under one-time colonoscopy versus sustained FIT strategies in the COLONPREV Trial.
Design : We conducted a post hoc per-protocol analysis of 17 270 screening initiators aged 50–69 years in eight Spanish regions, using inverse probability weighting to adjust for observed confounding and informative protocol deviations.
Results : Weighted 10-year risks were similar for CRC incidence (0.80% FIT vs 0.86% colonoscopy; risk difference (RD) 0.06%, 95% CI
−
0.25% to 0.37%) and all-cause mortality (4.02% vs 4.09%; RD 0.07%, 95% CI
−
0.76% to 0.84%). CRC mortality was lower with colonoscopy (0.072% FIT vs 0.042% colonoscopy; RD
−
0.03%, 95% CI
−
0.12% to 0.06%), but estimates were imprecise.
Conclusion : Sustained colonoscopy and FIT showed similar 10-year outcomes overall, highlighting the importance of adherence pathways in pragmatic screening trials.
Trial registration number ClinicalTrials.gov : NCT00906997.
Gut , article en libre accès, 2026