Clinical Gastroenterology and Hepatology · Feb 20, 2026
Systematic Review of Participation, Positivity, and Yield Over Time in Fecal Immunochemical Test-Based Organized Colorectal Cancer Screening Programs
By Baile-Maxía S, Pimienta M, Sánchez-Ardila C et al.
BACKGROUND & AIMS: Fecal immunochemical testing (FIT), the most common colorectal cancer (CRC) screening modality worldwide, requires programmatic participation over decades. We performed a systematic review and meta-analysis to ascertain overall adherence patterns, per-round participation, FIT positivity, and neoplasia detection rates in organized FIT-based screening programs, contrasting initial vs subsequent screening rounds. METHODS: We systematically searched the PubMed, Embase, and Cochrane databases. Adherence patterns were defined as consistent screeners (all rounds), intermittent screeners, and never attendants. Per-round participation, FIT positivity, and positive predictive values (PPVs) for CRC, advanced adenoma (AA), and adenoma were determined overall and for consistent screeners. Subgroup analyses were performed by screening periodicity and FIT positivity cutoff. RESULTS: Of 4414 candidate studies, 24 were included. Adherence patterns were: 47.1% (standard deviation [SD], 11.6%) consistent screeners, 22.7% (SD, 4.7%) intermittent screeners, and 30.3% (SD, 12.2%) never attendants. Overall pooled results from the first through fourth rounds showed per-round participation of 51.3% (95% confidence interval [CI], 37.4%-65.3%); 56.7% (95% CI, 41.3%-72.2%), 56.9% (95% CI, 38.7%-75.3%), and 56.5% (95% CI, 44%-68.6%); FIT positivity of 6.6% (95% CI, 5.9%-7.3%), 5.6% (95% CI, 4.6%-6.6%), 5.3% (95% CI, 4.0%-6.6%), and 5.3% (3.7%-6.9%); CRC PPV of 5.8% (95% CI, 4.1%-7.4%), 3.3% (95% CI, 2.3%-4.3%), 2.9% (95% CI, 2.2%-3.7%), and 2.5% (95% CI, 1.4%-3.5%); AA PPV of 32.8% (95% CI, 23.5%-42.0%), 28.3% (95% CI, 21.8%-34.7%), 22.7% (95% CI, 16.5%-28.9%), and 23% (95% CI, 10.1%-35.9%); and adenoma PPV of 48.6% (95% CI, 45.8%-51.4%), 46.2% (95% CI, 42.4%-50.1%), 48.7% (95% CI, 43.9%-53.6%), and 44.6% (95% CI, 38.2%-51.0%), respectively. Similar trends were observed for consistent screeners and for biennial FIT with 20 μg Hb/g feces positivity cutoff. CONCLUSIONS: Organized FIT-based CRC screening programs achieve consistent participation in nearly one-half of persons and no participation in approximately one-third. FIT-positivity and yields for CRC, AA, and adenoma are highest in the first round and may stabilize at clinically relevant steady states at the third to fourth rounds.