The go-to colorectal cancer screening test may not work equally well for everyone. A large retrospective study found that fecal immunochemical tests (FIT) are significantly more sensitive in detecting colorectal cancer and precancerous lesions in men than in women at the standard threshold — raising the question of whether gender-specific cutoffs are needed to close the gap.
The most widely used colorectal cancer (CRC) screening test in the world may be leaving women at a disadvantage. A large retrospective analysis of over 30,000 participants from the DeeP-C and BLUE-C clinical validation studies found that fecal immunochemical tests (FIT) are significantly more sensitive for detecting CRC and advanced precancerous lesions (APLs) in men than in women at the standard positivity threshold of 100 ng/mL.
Men had higher fecal hemoglobin levels and higher FIT sensitivity for both CRC and APLs. Women also had a higher proportion of proximal (harder-to-detect) cancers, where FIT sensitivity dropped sharply compared to men. To match men's CRC sensitivity, the threshold for women would need to be lowered — but that trade-off would reduce specificity and likely drive up colonoscopy referrals, adding complexity to an already stretched system.
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Why it matters: If FIT is systematically missing more cancers in women, clinicians should be cautious about reassuring female patients based on a negative result alone — especially if alarm symptoms are present. The findings spark an important conversation about whether one-size-fits-all screening thresholds are truly equitable.
