{
  "abstract": "Background Long-term adherence and results with faecal immunochemical test (FIT)-based colorectal cancer (CRC) screening are poorly characterised.Objective To characterise adherence and results through seven rounds in an organised biennial FIT-based CRC screening programme.Design We determined per-round FIT-completion, FIT-positivity, CRC and high-risk-CRC precursor positive predictive values (PPVs) and CRC detection/1000-FIT-participants for all invitees versus an adherent cohort (entry 50–51 years; 66–100% rounds completed) versus comparable-age first-ever screenings from 2010 to 2023. Joinpoint and multivariable logistic regression analyses identified trends.Results Adherence was consistent, frequent, occasional, infrequent and never (defined as 100%, 66–99%, 33–65%, 1–32%, 0% of rounds offered) in 29.2%, 8.6%, 11.5%, 4.5% and 46.2% of 2.81 million individuals, respectively. In both the all-invitee population and the adherent cohort, the first round yielded the highest FIT positivity (5.8%, 4.4%), PPVs for CRC (5.1%, 3.3%) and high-risk precursors (20.4%, 13.1%), and CRC detection rates (2.65, 1.30 per 1000 participants), respectively. Beyond three rounds, outcomes stabilised at levels substantially lower than those observed in first-time screeners of the same age (eg, CRC-PPV in seventh round: 1.6–2.2% at median age 62–65 vs 6.6% for new screeners aged 62–63). Colonoscopy completion after a positive FIT was high (87.3%).Conclusion After an initial round with the highest FIT-positivity and detection rates, screening outcomes stabilise at lower levels reflecting neoplasia removal and subsequent selection of a lower-risk population. Because detection rates remain clinically relevant even in an adherent cohort, early screening cessation after a sequence of normal biennial FITs is not justified.",
  "authors": [
    {
      "affiliations": [
        "Division of Gastroenterology and Hepatology and Department of Medicine, Stanford University School of Medicine, Stanford, California, USA"
      ],
      "name": "Uri Ladabaum"
    },
    {
      "affiliations": [
        "Pla Director d’Oncologia, L’Hospitalet de Llobregat, Catalonia, Spain",
        "Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain"
      ],
      "name": "Rebeca Font Marimon"
    },
    {
      "affiliations": [
        "Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain",
        "Research Network on Chronicity, Primary Care and Prevention and Health Promotion (RICAPPS), University of Pompeu Fabra, Barcelona, Spain"
      ],
      "name": "Xavier Castells"
    },
    {
      "affiliations": [
        "Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain"
      ],
      "name": "Francesc Balaguer"
    },
    {
      "affiliations": [
        "Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain"
      ],
      "name": "María Pellisé"
    },
    {
      "affiliations": [
        "Pla Director d’Oncologia, L’Hospitalet de Llobregat, Catalonia, Spain",
        "Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain"
      ],
      "name": "Judit Sola"
    },
    {
      "affiliations": [
        "Pla Director d’Oncologia, L’Hospitalet de Llobregat, Catalonia, Spain",
        "Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain"
      ],
      "name": "Josep Alfons Espinàs Piñol"
    },
    {
      "affiliations": [
        "Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain",
        "Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain"
      ],
      "name": "Antoni Castells"
    }
  ],
  "title": "Effect of long-term adherence on faecal immunochemical test positivity rate, positive predictive value and detection rate in organised population-based colorectal cancer screening",
  "uid": "aab15812-c548-5d80-b583-f1138d64e10f"
}