Pilot Evaluation of Fecal Immunologic Test (FIT) in Ontario
In 2008 Ontario launched the ColonCancerCheck (CCC) Program, an organized colorectal cancer
(CRC) screening program in which average risk patients are offered an at-home screening test
and increased risk patients are offered colonoscopy directly through their family physician.
Currently, Ontario's CCC Program utilizes guaiac fecal occult blood testing (gFOBT) in
persons at average risk of CRC. However, the program is currently considering a change to
fecal immunochemical testing (FIT).
FIT, which comes in quantitative and qualitative formats, is superior to the gFOBT from a
scientific perspective because it specifically detects human hemoglobin. gFOBT uses an
indirect detection which depends on a peroxidase reaction not specific for human hemoglobin.
FIT methodology is also both more convenient and superior from a participant perspective and
multiple studies have demonstrated higher participation rates and improved detection of CRC
precursors as well as invasive CRCs with FIT compared to gFOBT.
Organized CRC screening programs considering quantitative FIT face certain additional
challenges, including uncertain stability over time and tolerance to variation in
temperature following sample collection and prior to arrival in a testing laboratory. Prior
to implementation of FIT in Ontario, there is a need for a laboratory and field assessment
to validate and optimize its use in the Ontario climate and conditions (e.g., large
geographic area) and to determine whether adjustments to the current structure of the CCC
Program would be required.
This study consists of 2 phases. Phase 1, laboratory testing, assesses 2 quantitative and 3
qualitative FIT kits to evaluate analytical performance relevant to the requirements of the
CCC Program. Phase 2 is a field assessment to evaluate the effect of different distribution
and return methods and pre-labeling of kits on uptake and completion of the tests. The
entire study will take 12-18 months to complete, with patients being recruited through
family physicians in patient enrollment model (PEM) family practices across the province of
Ontario. Data collection will take place for 6 months, starting on the day that screening
kits and/or invitation letters are mailed to patients.
This Clinical Trials registration relates to Phase 2 of the study.
Allocation: Randomized, Intervention Model: Factorial Assignment, Masking: Open Label, Primary Purpose: Health Services Research
FIT Kit uptake
Comparing FIT kit uptake by patients invited to complete fecal occult blood screening for colorectal cancer using a Fecal Immunochemical Test (FIT), and provided with different kit distribution and return methods.
September 2012 to April 2013
Jill Tinmouth, MD, PhD
Sunnybrook Research Institute
Canada: Ethics Review Committee