Can a biomarker triage test reduce colonoscopy burden in fecal immunochemical test screening?

Marjolein Je Greuter, Beatriz Carvalho, Meike de Wit, Evelien Dekker, Manon Cw Spaander, Gerrit A. Meijer, Manon van Engeland, Veerle Mh Coupé

Research output: Contribution to journalArticleAcademicpeer-review


Aim: To assess the potential of biomarker triage testing (BM-TT) in the Dutch colorectal cancer (CRC) screening program. Materials & methods: Using the Adenoma and Serrated pathway to Colorectal CAncer model, we simulated fecal immunochemical test (FIT)47-screening and various FIT plus BM-TT screening scenarios in which only individuals with both a positive FIT and BM-TT are referred to colonoscopy. Results: Adding a low polyp sensitivity BM-TT to FIT-screening reduced colonoscopy burden (89-100%) while increasing CRC mortality (27-41%) compared with FIT47-screening only. The FIT plus high polyp sensitivity BM-TT scenarios also decreased colonoscopy burden (71-89%) while hardly affecting CRC mortality (FIT47 0-4% increase, FIT15 2-7% decrease). Conclusion: Adding a BM-TT to FIT-screening considerably reduces colonoscopy burden, but could also decrease screening effectiveness. Combining FIT15 with a high polyp sensitivity BM-TT seems most promising.
Original languageEnglish
Pages (from-to)563-571
Number of pages9
JournalJournal of comparative effectiveness research
Issue number8
Publication statusPublished - 1 Jun 2020


  • biomarker test
  • colorectal cancer screening
  • screening burden
  • triage testing

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