What an abnormal FIT result really means

In November 2013 British Columbia’s Colon Screening Program became fully available across the province. This important new program offers colorectal cancer screening to asymptomatic men and women between the ages of 50 and 74. 

Individuals at average risk are screened using the fecal immunochemical test (FIT), which has been available in British Columbia for the past 5 years and has been covered by MSP since April 2013. Because FIT is a relatively new test in this province, there has been some confusion about the test, particularly when there is an abnormal result.

FIT is a quantitative test with a threshold of 50 nanograms per millilitre of hemoglobin. While FIT is a good screening test, it is important that patients understand that FIT is not a diagnostic test, regardless of the level of blood present in the sample submitted.

FIT can only tell us that there may be bleeding from somewhere in the lower digestive tract. It cannot tell us from which part or why. Blood can be present in the stool for many reasons, including hemorrhoids, ulcers, anal fissures, diverticular disease, or inflammation. And, like any test, FIT may give an abnormal result even though there is nothing wrong.

On average, 15% of individuals screened with FIT will have an abnormal FIT result and will require additional testing. This does not mean that a cancer was found—over 96% of those with an abnormal FIT will not have cancer. Some of these patients may have adenomas (precancerous polyps). Most adenomas will never turn into cancer, and for those that do, it will take many years for this transition, which is why patients should be screened regularly. 

Colonoscopy is necessary after an abnormal FIT to ensure that no cancer is present. Removal of adenomas at colonoscopy has been shown to decrease the mortality and incidence of colorectal cancer. Colonoscopy is a safe and accurate test, and quality assurance programs are being implemented throughout the province to ensure the safety and efficacy of colonoscopy are maximized.

For more information on FIT or the Colon Screening Program, visit www.screeningbc.ca. 
—Jennifer J. Telford, MD
Medical Director, BC Cancer Agency Colon Screening Program

Jennifer J. Telford, MD,. What an abnormal FIT result really means. BCMJ, Vol. 56, No. 2, March, 2014, Page(s) 97 - News.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply