SynthesisBMC gastroenterology2026
One- versus two-sample fecal immunochemical testing for colorectal cancer screening: a systematic review and meta-analysis of participation, diagnostic performance, and cost-effectiveness.
Synthesis in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
backgroundWhether collecting one or two fecal samples for immunochemical testing (FIT) optimizes colorectal cancer screening outcomes remains unclear.
methodsWe systematically searched multiple databases until October 2025 for studies directly comparing 1-FIT and 2-FIT strategies. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes.
resultsFive studies (n = 45,888) and three economic evaluations were included. Participation was higher with 1-FIT (RR = 1.05, P < 0.0001), while 2-FIT had a higher positivity rate (RR = 0.65, P < 0.0001). Although 2-FIT detected more CRC (RR = 0.62, P = 0.02), advanced neoplasia and advanced adenoma detection were similar. The 2-FIT strategy had higher sensitivity (RR = 0.64, P = 0.04) but lower specificity (RR = 1.70, P < 0.001) than 1-FIT. A pivotal finding was that the 1-FIT strategy demonstrated a superior positive predictive value (PPV) for both advanced neoplasia (RR = 1.21, P = 0.004) and advanced adenoma (RR = 1.41, P < 0.0001), which translated into a substantially lower demand for colonoscopy (RR = 0.64, P < 0.0001) Economic evaluations consistently favored 1-FIT across different healthcare systems.
conclusionAlthough the 2-FIT strategy improves test sensitivity, it fails to enhance advanced neoplasia detection while substantially increasing colonoscopy demand due to its reduced positive predictive value. In contrast, the 1-FIT strategy preserves screening efficacy with superior participation rates, resource utilization, and cost-effectiveness. We recommend 1-FIT as the preferred strategy in settings with constrained colonoscopy resources, while reserving 2-FIT for resource-abundant environments where maximizing sensitivity justifies the additional economic and operational costs (Scheme 1).
trial registrationThe research protocol was prospectively registered in the PROSPERO registry, bearing the registration identifier CRD420251153202.
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