Fecal Immunochemical Test as a Screening Method for Colorectal Cancer in University College Hospital Ibadan, Nigeria

Abstract

PURPOSE Colorectal cancer (CRC) is a disease of public health importance because of the increasing incidence of the disease and presentation in advanced stage of the disease in Western Africa. CRC is amenable to screening because of the long course of premalignant lesions before final development of the disease. Despite this, the practice of CRC screening is inadequate at the sites in this study. The fecal immunochemical test (FIT) is one of the recommended noninvasive methods for CRC screening. It has a sensitivity of 96%, specificity of 90%, and an overall accuracy of 95%. We aimed to determine the practicability of FIT for CRC screening in patients aged 40 to 75 years who attended primary care clinics in the University College Hospital, Ibadan, Nigeria. PATIENTS AND METHODS A total of 422 patients selected by systematic random sampling were recruited and offered free FIT screening. Participants with a positive finding had additional GI examination, including a digital rectal examination, proctoscopy, and colonoscopy, if no lesion was biopsied during proctoscopy. RESULTS The mean (± standard deviation) age of the respondents was 62 ± 9.61 years. The prevalence of a positive FIT in the study was 10.1%. The FIT was not completed by 3.8% of patients, and the rate of completion of additional evaluation after a positive FIT reduced as the investigations became invasive, with 36.8% and 71.1% noncompletion rates for proctoscopy and colonoscopy, respectively. CONCLUSION A FIT-based screening for age and risk-appropriate patients is practical in this environment, where the capacity and acceptability of colonoscopy are limited.

Barriers and recommendations for colorectal cancer screening in Africa

“…In particular, religion strongly impacts how people relate to health care and medicine, and physician consultations upon initial symptom presentation are not typical [ 18 ]. A similar cultural attitude is found in Nigeria [ 25 ] and Egypt [ 23 ].…”

“…Knapp et al [ 24 ] also mentioned that 100% of participants who completed the test kit reported a willingness to undergo colonoscopy if it was free (~90% with a positive FIT result underwent follow-up colonoscopy). The follow-up colonoscopy rates in the other studies were much lower, ranging from 18% to 66% [ 22 , 25–27 ] ( Table 2 ).…”

“…One commonly reported barrier to CRC screening in African countries was the limited availability of endoscopic resources [ 13 , 17–21 ] ( Table 1 ). Eight studies have identified the lack of infrastructure as a barrier to CRC screening, more specifically the lack of equipment and facilities [ 13 , 17 , 19 , 21 ] ( Table 1 ) and the limited capacity of colonoscopy [ 22 , 25–27 ] ( Table 2 ). Rejaibi et al [ 26 ] mentioned that colonoscopy without sedation was not acceptable to participants, highlighting the lack of supplemental resources needed to improve the patient experience.…”

“…Organised CRC screening programs have been effective, with most study participants undergoing CRC screening via FIT (90–98%) and all eligible participants undergoing FOBT [ 22 , 24–27 ]. In the study by Labaeka et al [ 25 ], the failure for patients to complete a FIT was ascribed to misplacing the kit, travelling out of town or being lost to follow-up. Three studies mentioned feedback from participants who completed FIT [ 22 , 24 , 27 ]: 82–89% of participants reported that the test kit was easy to use/complete and 90–100% of participants said they would recommend the FIT to friends and family.…”

Feasibility and performance of the fecal immunochemical test (FIT) for average-risk colorectal cancer screening in Nigeria

“…A prospective, multi-center, Nigerian study of 362 patients with a recent history of self-reported rectal bleeding documented an ADR of 8.2%, despite a CRC prevalence of 18.2% (66/362) [ 27 ]. In a recent prospective study from the University College Hospital in Ibadan, Nigeria, the ADR was 9.1% among asymptomatic adults undergoing CRC screening [ 28 ]. A lower proportion of traditional adenomas may decrease FIT performance as the sensitivity of the test is inferior for non-adenomatous polyps (e.g.…”