Pinnacle Biolabs' Second Generation FIT offers results in minutes, and it is reportedly the top-selling colon cancer screening test in North America. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false-positive (FP) results adding to colonoscopy burden without improving cancer detection. Two authors (A.K. To assess the diagnostic accuracy of FIT for CRC or advanced neoplasia (AN) in asymptomatic patients at above-average risk. RM, Whiting Terms of Use| Data Sources FIT only detects human blood from the lower intestines. The new study, published in Alimentary Pharmacology & Therapeutics, concluded that a positive test of ten micrograms or more of haemoglobin per gram of sample detects 91% of underlying cancers. Because the fecal occult blood test (FOBT) was not as accurate, the fecal immunochemical test (FIT) was developed. Thus, our results suggest that in increased-risk individuals FIT has high diagnostic accuracy for CRC. All Rights Reserved. Statistical analysis was performed with Stata software version 13.0 (Stata Corporation), using metandi and midas modules. The positive result could be caused by a stomach ulcer, hemorrhoids, other inflammation. et al; GRADE Working Group. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, 2017;177(8):1110-1118. doi:10.1001/jamainternmed.2017.2309. Diagnostic yield of the immunochemical fecal occult blood test in asymptomatic first degree relatives of colorectal cancer patients. Bariatric Surgery May Reduce Risk of Common Cancers, U.S. Department of Health and Human Services. independently extracted data and evaluated study quality using the Quality Assessment of Diagnostic Accuracy Studies2 tool, and evaluated the quality of the body of evidence by means of GRADE (Grading of Recommendations Assessment, Development, and Evaluation). moderator 3rd September 2020. Given the safety, simplicity, low cost, and minimal discomfort of FIT, it is a viable alternative screening strategy for patients at increased risk for CRC. The average sensitivity of FIT for CRC was 93% (95% CI, 53%-99%), and the average specificity was 91% (95% CI, 89%-92%), yielding a positive likelihood ratio (LR+) of 10.30 (CI 7.7-13.9) and a negative likelihood ratio (LR) of 0.08 (95% CI, 0.01-0.75) (GRADE: very low). RC. Not a virtual colonoscopy, or another stool test, or another scan of some sortyou need a real optical colonoscopy. JK, Liles Multiple factors can contribute to people not getting follow-up colonoscopy exams, both he and Dr. Breslau said. This delayed diagnosis likely explains the higher death rate from colorectal cancer in this group, Dr. Breslau said. We synthesized existing data using hierarchical models to account for the correlation between sensitivity and specificity. Positive and negative predictive values were 7.7% and 99.9%, respectively. The pooled sensitivity was approximately 93% for CRC but much lower for AN (48%). L, Brozek A prospective, controlled, feasibility study. SP, Young Colonoscopy-controlled intra-individual comparisons to screen relevant neoplasia: faecal immunochemical test vs. guaiac-based faecal occult blood test. BM, Parton One . Critical revision of the manuscript for important intellectual content: All authors. et al. Lin AH. LA, You can change these settings at any time, but that may impair functionality on our websites. van Rossum It is also important to establish optimal thresholds, test cutoff values, and number and frequency of FIT samples.10 Our results also should prompt randomized trials to assess the implementation of FIT either alone or in combination with other screening procedures into screening strategies for increased-risk individuals. Annual fecal immunochemical testing (FIT) is cost-effective for colorectal cancer (CRC) screening. In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., Colonoscopy after Positive FIT Test Cuts Risk of Colorectal Cancer Death was originally published by the National Cancer Institute., January 12, 2023, In a study from the Netherlands, 4523 people (age range, 50-74) underwent FIT screening with OC-Sensor Micro; a hemoglobin concentration of 50 ng/mL was considered positive. Three-year survival was greater in the CRC group diagnosed after a positive FIT (72% vs 59%). Harbord Pooled test characteristics estimates for diagnosing CRC were sensitivity, 86% (95% CI, 31%-99%); specificity, 91% (95% CI, 89%-93%); LR+, 10.00 (95% CI, 5.80-17.5); and LR, 0.16 (95% CI, 0.02-1.48). Washington, DC 20001 Hierarchical summary receiver operating curve (HSROC) plot of sensitivity versus specificity for performance of FIT in studies using quantitative FIT with cut off value less than 25g/g only in patients with familial risk of CRC, eTable 1. This test uses antibodies that specifically react with a blood protein in the stool. FIT (Fecal Immunochemical Test) is a stool test used to look for possible signs of colorectal cancer. We estimated whether non-compliance with colonoscopy after a positive FIT is associated with increased CRC incidence and mortality. Tumors were stratified by location. Oort Systematic Review Data Repository. JY, Chan and P.P.) Methods The FIT-based CRC screening programme in the Veneto region (Italy) invited persons aged 50 to 69 . The Bayesian estimate from the positive test result is almost seven times the assumed 0.7% prevalence. The test looks for tiny traces of blood in the stool, a way of screening people for colon cancer. The test isn't always accurate. NC. Finally, we checked reference lists of primary studies included, relevant systematic reviews and meta-analyses, and pertinent guidelines. C, Zubiaurre In this systematic review and meta-analysis, we found reasonable diagnostic accuracy of FIT for CRC (AUC, 0.93) and AN (AUC, 0.86) in individuals with either a personal or family history of CRC. Overall quality was deemed very low, low, moderate, or high using GRADEpro version 3.6 (GRADEpro GDT). This review was based on a prespecified protocol registered with PROSPERO 2016 (CRD42016037924) and is reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.12. CG, Allison Reitsma Rutter G, Huang The FIT identified patients with CRC with overall high sensitivity but missed nearly 50% of small (T1) and 32% of UICC stage I CRCs. In the study, Imperiale and his colleagues determined that when the FIT was set to be more sensitive, the test caught 95 percent of cancers, but resulted in 10 percent false positives. Parekh Drafting of the manuscript: Katsoula, Paschos, Tsapas. AZ, Quintero Statistical analysis: Katsoula, Paschos, Haidich, Tsapas. The researchers identified 268 cases of CRC from a database search of 96,804 subjects ages 5075 years with initial negative FIT results. In this meta-analysis, FIT has high overall diagnostic accuracy for CRC and moderate accuracy for advanced neoplasia. Are fit tests accurate? DA, McFarland These findings confirm the results of previous reports that showed that early stage CRCs and advanced adenomas are less likely to bleed than advanced-stage CRCs, as well as studies that reported that FIT sensitivity (especially for early-stage CRC or advanced adenomas) decreases with higher cutoff levels, they summarized. A, Bujanda independently extracted data and evaluated study quality using the Quality Assessment of Diagnostic Accuracy Studies2 tool, and evaluated the quality of the body of evidence by means of GRADE (Grading of Recommendations Assessment, Development, and Evaluation). These data therefore are providing additional evidence supporting the adoption of a 2-year interval for FIT screening, wrote Senore and Zorzi. We also conducted a series of prespecified subgroup analyses, based on type of FIT (qualitative or quantitative), number of samples (1, 2, or 3), or FIT cutoff used. RW, If cancer is detected, treatment is usually the next step. Effect of Single-Dose Aspirin Prior to FIT on Colorectal Cancer Detection. Finally, we graded the quality of the body of evidence using appropriate methodology (GRADE). Chubak et al reported that the return rate of any stool blood test after kit mailing within 6 months was 69% versus 64% (P < .005) for 1-sample versus 2-sample testing, respectively, 11 whereas Mosen et al reported that the kit return rate within 6 months was 43.4% versus 39.6% (P = .012), respectively. H, Bishehsari et al. AACC.org ME, Levi High specificity and sensitivity of FIT allow prompt referral of patients with positive results for further diagnostic investigation with colonoscopy, and exclusion of CRC with high certainty in individuals with negative results respectively. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. et al. Both studies focused on a single screening episode analysis, which cannot account for the potential contribution of repeated FIT applications to overall screening effectiveness, they added. Fecal immunochemical test (FIT). What is the diagnostic accuracy of fecal immunochemical testing (FIT) for screening of colorectal cancer (CRC) or advanced neoplasia in asymptomatic high-risk populations? DC, Curry Schnemann H, Brozek J, Guyatt G, Oxman A, ed; GRADE Working Group. The rate of early-stage disease was also higher in this group (51.3%) than in the group 2 (45.5%). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. The study points to the importance of more closely monitoring people who do not follow recommendations after a positive FIT result, said Erica Breslau, Ph.D., M.P.H., of NCIs Healthcare Delivery Research Program, who also was not involved in the study. // Colorectal cancer screening comparing no screening, immunochemical and guaiac fecal occult blood tests: a cost-effectiveness analysis. Corresponding Author: Anastasia Katsoula, MD, MSc, Hippokration General Hospital of Thessaloniki 54642, Thessaloniki, Greece (anastkatsoula@gmail.com). Gimeno-Garca Fraser JS, Piper EA, Jaeschke Experts generally recommend that people repeat this test every 1 to 2 years. et al. We explored the robustness of our results in a post hoc sensitivity analysis including only studies in patients with family history of CRC that used quantitative FIT with a cut-off value of less than 25 g Hb/g feces. Understanding why some people are willing to be screened but do not follow up can lead to improvements in the effectiveness of the screening process.. May 5, 2022 , by Elia Ben-Ari. MEDLINE, EMBASE, Cochrane Library, and gray literature sources through August 2016. The faecal immunochemical test (FIT) is a screening test for bowel cancer that can be completed in the privacy of your home. Complications of colonoscopy. FIT costs about $20 or less and is covered by Medicare and most health insurance plans. Robertson JL, Akl Further, she also stated that 9 out of 10 patients who have a positive FIT test DO NOT have cancer. Respective estimates for AN were sensitivity, 47% (95% CI, 39%-55%); specificity, 94% (95% CI, 91%-96%); LR+, 8.10 (95% CI, 5.90-11.20); and LR, 0.56 (95% CI, 0.49-0.65) (eFigure 6 in the Supplement). Effectiveness: According to the USPSTF report, when the patient has colon cancer, the test is likely to indicate its presence 62% to 79% of the time. A positive test can mean other conditions however. This test examines DNA in your stool for evidence of cells shed by colorectal cancer. Colorectal Cancer: Estimated Incidence, Mortality and Prevalence Worldwide in 2012. Despite the use of an exhaustive and meticulous search strategy, we could only find 12 eligible studies. M, Gimeno-Garcia Free phone consultations with a registered nurse is available for people who test positive for a medical condition using one of LetsGetChecked tests. Colonoscopy is an invasive, expensive procedure with an established risk of complications.40,41 Population-based studies and randomized trials suggest that adherence to use of colonoscopy for screening in average and increased-risk populations is usually suboptimal.42 This undermines the efficacy of screening programs43 and underlines the need for alternative screening modalities that may limit the need for colonoscopy only to those participants with positive results. The FIT identified that there was blood in the stool. Quintero Given the safety, simplicity, low cost, and minimal discomfort of FIT, it is a viable alternative screening strategy for patients at increased risk for CRC. So, in 10 percent of cases using . H, Synopsis of results from sensitivity analyses depending on risk of bias, patient population and reference standard used for the diagnosis of colorectal cancer and advanced neoplasia, eTable 2. FIT is one of the most widely used colorectal cancer screening tests worldwide. AM, Ladabaum 1 In order to reduce mortality and incidence of CRC, the National Health Service Bowel Cancer Screening Programme (NHS BCSP) in . Reasons for participation and nonparticipation in colorectal cancer screening: a randomized trial of colonoscopy and CT colonography. K, Robinson Who should be screened for colon cancer? Accessibility Statement, Our website uses cookies to enhance your experience. The last search was performed in August 2016 (eFigure 1 in the Supplement). Fecal immunochemical test (FIT). Fecal Immunochemical Test (FIT): common questions. No pre-test diet or medication changes needed. MEDLINE, EMBASE, Cochrane Library, and gray literature sources through August 2016. et al; QUADAS-2 Group. That . Recommendations on Fecal Immunochemical Testing to Screen for Colorectal Neoplasia: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer. A positive test result means that 20 micrograms or more of haemoglobin (a protein found in red blood cells) per gram of poo was . R, Can miss many polyps and some cancers. Only 3% of people with a positive FIT test have cancer (and less than 1% have advanced colorectal cancer), and remember that figure comes from studies whose participants were 50+. Conclusions and Relevance Among patients with a positive fecal immunochemical test result, compared with follow-up colonoscopy at 8 to 30 days, follow-up after 10 months was associated with a higher risk of colorectal cancer and more advanced-stage disease at the time of diagnosis. There are two types of stool tests for colon cancer. Specifically, the investigators wanted to see if a colonoscopy identified any cancer missed by the FIT. In the study, 3 percent of the people with positive FIT results were diagnosed with colorectal cancer (2,191 total cases). How Fit Is FIT for Detecting Colorectal Cancer? independently reviewed and screened titles and abstracts of articles retrieved and determined final eligibility through examination of full texts. US Department of Health & Human Services Agency for Healthcare Research and Quality. DG; PRISMA Group. Dr. Zorzis team found that people in the no-colonoscopy group were at higher risk of dying from all causes, not just from colorectal cancer. Importance We fitted hierarchical logistic regression models when 4 or more studies were available.21-24. Low adherence to colonoscopy in the screening of first-degree relatives of patients with colorectal cancer. The FIT test, or fecal immunochemical blood test, is a newer and more accurate way to test for blood in stool, which can be a symptom of colon cancer. However, recommendations for increased-risk individuals are more aggressive and support only use of colonoscopy. The trials reported a low positive predictive value (PPV) for the FOBT test, suggesting that most positive tests were false positives. Such factors include the patients personal circumstances (for example, access to transportation), whether they have health insurance, whether they can get timely access to colonoscopy, and whether they have had an adequate conversation with their doctor about screening. By contrast, in the no-colonoscopy group, new cases went up more gradually but continued rising over 10 years. (DNA tests, however, do return more . Fecal immunochemical test (FIT) No direct risk to the colon. Bacchus Grading quality of evidence and strength of recommendations in clinical practice guidelines: part 3 of 3. the GRADE approach to developing recommendations. A. JJ, Burnand J, Kallenberg Many colorectal cancer screening programs, including some in the United States, struggle to ensure timely colonoscopy completion among those with a positive FIT, with rates as low as 50%, Dr. Zorzi and his colleagues wrote. Mine were hemorrhoids. FA, Terhaar Sive Droste In the colonoscopy group, the number of new colorectal cancers diagnosed went up sharply in the first 6 months or so after a positive FIT result and leveled off after that. The primary outcome was the diagnostic performance of FIT for detecting CRC or AN. I asked what did it show, because they test for 11 different cancers or categories. PM, Zwinderman New research underlines the importance of following up with a colonoscopy exam after a positive (abnormal) result on an at-home stool test to screen for colorectal cancer. keeping a . Mean age ranged from 46.0 to 63.2 years, and percentage of males ranged from 30.2 to 50.6%. Berger All Rights Reserved. The first stool tests developed were based on the finding of occult, or hidden, blood. An abnormal . TR, Corley The area under the ROC (AUC) for diagnosis of CRC and AN was 0.93 (95% CI, 0.90-0.95) and 0.86 (95% CI, 0.83-0.89), respectively (eFigure 4 in the Supplement). P, However, in 3 studies, the time interval between FIT and colonoscopy depended on the FIT result, such that colonoscopy was delayed more so in those with a negative FIT.26,34,37. et al. Quality assessment summary: review authors judgments about each risk of bias item for each included study, eFigure 3. Data extraction and quality assessment were conducted in duplicate. Only about 4% of people will have cancer found on colonoscopy. The Cologuard test has a 12% false-positive rate, which means 1 in 10 positive tests will incorrectly identify cancer or polyps. Meaning et al; US Preventive Services Task Force. Main Outcomes and Measures Hunt et al. At 76.6-85.8%, 1 the specificity of FIT at a cut-off of 10 is relatively high but this means that up to 25% of patients will have a false-positive result. et al. eFigure 2. JS, Van Der Hulst 20 participants of the 47 who had polyps had advanced adenomas . Results for all subgroup analyses are summarized in Table 2. E, We undertook a comprehensive search of multiple electronic databases and gray literature sources without imposing any restrictions based on language or publication type. The researchers compared the numbers of new colorectal cancer cases diagnosed, deaths from colorectal cancer, and deaths from any cause in the two groups over time for up to 10 years after an initial positive FIT result. Quiz Ref IDDespite the use of an exhaustive and meticulous search strategy, we could only find 12 eligible studies. Importance The potential role of the fecal immunochemical test (FIT) for screening patients at increased risk for colorectal . However, the validity of our conclusions is undermined by low or very low quality of the body of evidence. et al. Needs to be done every year. In our main analysis, FIT sensitivity and specificity for diagnosing CRC ranged from 0.25 to 1.00 (median, 0.81) and from 0.87 to 0.95 (median, 0.91), respectively. FIT testing is recommended annually, and Cologuard every three years if testing is negative, but positive test results require a follow-up with colonoscopy. Less than 1 percent of these (601 cases) were advanced cancers. independently evaluated the quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool.15 Discrepancies were resolved by consensus. Collectively, two studies found that FIT performs poorly in identifying early-stage CRC but serves some benefit as a periodic screening tool. et al. You just need to follow instructions with the FIT kit to obtain a stool sample and return it to a lab. L, Sarasqueta P, Leshno Cost. et al; EPICOLON Group. HE, Halloran The ongoing NCI-funded PROSPR program aims to better understand how to improve the cancer screening process and reduce disparities in colorectal and other cancer screening in community health care settings in the United States. The Cologuard test has a 13% false-positive rate, which means 1 in 10 positive tests will incorrectly identify cancer or polyps. Hazazi MA, Perdue They said, it just states either negative or positive for cancer. D, Hernndez-Guerra 12 Data from outside the United States . GM, Baron et al. Quantitative and 1-sample FIT showed adequate test performance, but data on other FIT brands and multiple samples were insufficient. et al; American Cancer Society Colorectal Cancer Advisory Group; US Multi-Society Task Force; American College of Radiology Colon Cancer Committee. Findings come from a study that is part of a larger effort to address screening disparities. It tests for hidden blood in the stool, which can be an early sign of cancer. From these findings, they concluded that a periodic FIT was an accurate test in people with average CRC risk. The methodological quality assessment of the included studies is summarized in eFigures 2 and 3 in the Supplement. Chemical and immunological testing for faecal occult blood in screening subjects at risk of familial colorectal cancer. No bowel prep. Hierarchical models were used to synthesize available evidence. and P.P.) But the program in northeast Italy, which started in 2002, has maintained colonoscopy rates of 80% at just 3 months after a positive test result, they noted. Anyway, if you get a positive test, do yourself a favor, don't diagnose yourself and stay off the internet. Lastly, she said that 3 out of four people have polyps, hemorrhoids, ulcers, or a combination of the three. FIT has now supplanted gFOBT in the pathway for symptomatic patients. What is a FIT? Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Colon cancer screening is appropriate for: Adults 45 and older with an average risk for colon cancer. These data indicate that participants who begin screening at the . FIT has high overall diagnostic accuracy for CRC in increased-risk individuals. We assessed the full text of the remaining 202 reports. by Carmen Phillips, December 2, 2022, My test results came back positive. It is really a good thing that you are fast tracked for a colonoscopy, as it will be the only way to know what's going on. We conducted a systematic review and meta-analysis to explore the diagnostic accuracy of FIT for CRC or advanced neoplasia (AN) in asymptomatic individuals with a familial or personal history of CRC. Two authors (A.K. Quintero The PPV was 5.0% to 18.7% in the trials using nonrehydrated slides (Funen and Nottingham studies), and it was 0.9% to 6.1% in the trials using rehydrated slides (Goteborg and Minnesota studies). the bowel cancer screening test detects most (up to 85%) but not all bowel cancers; This is why it's important to do the screening test every 2 years between 50 and 74. Published Online: June 19, 2017. doi:10.1001/jamainternmed.2017.2309. A positive FIT can also be due to a polyp, a pre . Faecal immunochemical test accuracy in patients referred for surveillance colonoscopy: a multi-centre cohort study. AF, Laheij Studies have shown that this type of test detects cancer with 92 percent accuracy. M, Fendrick JA, Eisen Several recently published guidelines support the use of FIT for screening of average-risk participants.44,45 The Canadian Task Force on Preventive Health Care excludes colonoscopy as a primary screening test and recommends screening only with FIT, guaiacbased fecal occult blood tests, or flexible sigmoidoscopy.46 Our results are in line with these suggestions and support use of FIT for screening of increased-risk individuals. How Fit Is FIT for Detecting Colorectal Cancer? Sensitivity was particularly low for T1 and stage I cancers in the distal colon (32% and 52%, respectively) although generally very high for cancers with higher T stage (T2-T4) and more advanced stage (UICC stage . Respective values for AN were sensitivity, 44% (95% CI, 34%-53%); specificity, 94% (95% CI, 92%-96%); LR+, 7.70 (95% CI, 5.10-11.70), and LR, 0.60 (95% CI, 0.51-0.71) (eFigure 5 in the Supplement). JE, Halloran PF, Rutjes Until now, there hasnt been much information on how a lack of follow-up testing after a positive FIT result may affect peoples risk of dying from colorectal cancer, Dr. Corley noted. Wong One study we published showed that by increasing screening rates from 40% to 80%, we could cut the incidence of colorectal cancer deaths in half, he said. 95 percent CI 5.1-9.3 percent predicts FIT will be positive in this low-risk symptomatic group, whereas 99.8 per cent CI 99.5-99.9 per cent predicts FIT would be negative. Applying Grading of Recommendations Assessment, Development and Evaluation (GRADE) to diagnostic tests was challenging but doable. Diagnostic tests 4: likelihood ratios. Carroll The average sensitivity of FIT for AN was 48% (95% CI, 39%-57%); and the average specificity was 93% (95% CI, 91%-94%), yielding an LR+ of 6.55 (95% CI, 5.0-8.5) and an LR of 0.57 (95% CI, 0.48-0.67) (GRADE: very low). van Rossum It has recently been suggested that fecal immunochemical testing (FIT) could be used for population-based screening owing to its high accuracy and adherence.7-9 Previous systematic reviews and meta-analyses have assessed the performance of FIT in average-risk populations.10,11 However, the potential role of FIT for screening of individuals at increased risk for CRC has not yet been fully elucidated. et al. NCCN Guidelines For Colorectal Cancer Screening (Version 2.2016). The Journal of Applied Laboratory Medicine, A Global Strategy to Eliminate Cervical Cancer, A New Model for Personalized Reference Intervals, How Fit Is FIT for Detecting Colorectal Cancer, How Underspecification Undermines Artificial Intelligence, The Sprint Toward a Better SARS CoV 2 Diagnostics Data System, Commission on Accreditation in Clinical Chemistry. Six studies were deemed at high risk of bias,26,28,30,32,34,37 1 study at unclear risk,36 and 5 studies at low risk of bias.27,29,31,33,35, All but 1 study reported use of consecutive or random sampling.30 FIT was used prior to the reference standard in 11 studies, and only 1 study did not provide relevant data.36 All studies used prespecified FIT thresholds. But if it is cancer, finding it at . When a guaiac FOBT is performed every one to two years in adults 50 to 80 years old, it can reduce deaths from colorectal cancer by 15 to 33 percent, according to the National Cancer Institute . For the study, Manuel Zorzi, M.D., M.Sc., of the Veneto Tumour Registry in Padua, Italy, and his colleagues, examined the medical records of participants in a regional colorectal screening program who took a FIT test between January 1, 2004, and September 30, 2017. Male sex (OR = 1.30, 95%CI 1.03, 1.62), age 65 years (OR = 1.27, 95%CI 1.01, . GP; Expert Working Group on Fecal Immunochemical Tests for Hemoglobin, Colorectal Cancer Screening Committee, World Endoscopy Organization. independently extracted data from each included study, using Systematic Review Data Repository.13 For studies presenting results for multiple FIT thresholds, we extracted all data to maximize the yield of information. // A, Bowel cancer (colorectal cancer, CRC) is the second most common cause of cancer death in the UK, accounting for 10% of all cancer deaths in 2017.
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