Sex- and Age-Stratified Outcomes of Colonoscopy Versus Faecal Immunochemical Testing: Post-Analysis of the COLONPREV Study

Abstract

Background Colorectal cancer (CRC) screening is effective and cost-effective in average-risk individuals. The COLONPREV study recently showed that individuals invited to a faecal immunochemical test (FIT) were more likely to participate in screening than those invited to colonoscopy, and that FIT-based screening was non-inferior to colonoscopy with respect to CRC-related mortality and CRC incidence.

Objective To assess whether the outcomes of colonoscopy- and FIT-based screening differ according to sex and age in the invited population.

Methods Presumptively healthy men and women aged 50–69 years were randomised to either a one-time screening colonoscopy or biennial FIT. In this analysis, we report participation and crossover rates, CRC-related mortality, CRC incidence, all-cause mortality, and diagnostic yield for both screening strategies, stratified by sex and by age group (50–59 and 60–69 years).

Results The eligible population consisted of 26,332 individuals assigned to colonoscopy and 26,719 assigned to FIT. As expected, participation and crossover rates were higher in women than in men and in older individuals compared with younger individuals. Participation was also consistently higher in those invited to FIT screening than in those assigned to colonoscopy across both sexes and age groups. The observed reductions in CRC-related mortality and CRC incidence, which were consistent across both screening strategies, were independent of sex or age. However, CRC-related mortality, all-cause mortality, and CRC incidence remained higher in men and older participants than in women and younger participants. Colonoscopy screening showed a higher diagnostic yield of premalignant precursor lesions across all demographic subgroups.

Conclusion Participation and reductions in CRC-related mortality and incidence were consistent across sex and age groups for both FIT- and colonoscopy-based screening strategies. The higher baseline risk observed in men could not be fully mitigated by screening.