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NewsThe standard fecal immunochemical test (FIT) for colorectal cancer screening is significantly less sensitive in women than men, a large retrospective study found. Men had higher fecal hemoglobin levels and FIT sensitivity for both cancers and precancerous lesions. Researchers say lowering the FIT positivity threshold for women could help close the detection gap — but comes with real trade-offs.
The world's most widely used colorectal cancer (CRC) screening test may be missing more cancers in women than men. A retrospective analysis of over 30,000 participants, presented at the ACG Annual Scientific Meeting, found that fecal immunochemical testing (FIT) is significantly more sensitive in men at the standard positivity threshold of 100 ng/mL — raising questions about whether a one-size-fits-all approach is truly equitable.
The gap comes down to biology and tumor location. Men tend to have higher fecal hemoglobin levels and more distal (easier-to-detect) lesions, while women are more likely to have proximal cancers, which bleed less and are harder for FIT to pick up. Researchers found that to match men's CRC detection sensitivity, the FIT threshold for women would need to drop to just 12 ng/mL — but that would reduce specificity to 75.7%, meaning more false positives and unnecessary follow-up colonoscopies.
By the Numbers:
Why it matters: If screening programs aim for equal cancer detection across sexes, the current FIT threshold may need to be sex-specific. But any change involves real trade-offs between sensitivity and specificity — and the right answer may vary depending on which FIT brand is used.
