Utility of Fecal Immunochemical Test in Screening for Colorectal Cancer in Egyptian Individuals with Family History of Advanced Colonic Neoplasia

Colorectal cancer (CRC) has a presumable low incidence in Egypt which did not rationalize for the development of screening programs up till now. The fecal immunochemical test (FIT) can facilitate colonoscopy uptake and increase enrollment in CRC screening programs. We aimed to explore the attitude of Egyptian individuals towards screening colonoscopy and establish the accuracy of FIT to detect advanced colonic neoplasia (AN). In this cross-sectional study, we offered a questionnaire to 1470 subjects with a family history of AN to establish their attitude towards the use of either direct colonoscopy (group A) or 2 step screening strategy; utilizing FIT followed by colonoscopy (Group B). Eventually, all included individuals underwent both FIT and colonoscopy. A total of 547 persons of the interviewed population (37.3 %) agreed to participate in the study, and group A cohorts were more likely to accept colonoscopy invitations. A single cycle FIT had a sensitivity of 76.2% a specificity of 92.2%, a positive predictive value of 28.1.2%, and a negative predictive value of 99%. The incidence of AN among the screened population was 3.9%, and CRC was found in 2 patients (0.4%). Uptake of colonoscopy is more likely, if the invitation strategy was a direct colonoscopy invitation. A single-round FIT test had good sensitivity and specificity to detect AN. Egypt has a low incidence of CRC in individuals with a family history of CRC.