A retrospective analysis of more than 30,000 screening participants, presented at the American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting, found that fecal immunochemical testing (FIT) was less sensitive for colorectal cancer (CRC) and advanced precancerous lesions in women than in men at the standard positivity threshold.
Using a threshold of 100 ng/mL, FIT detected 62.0% of CRC cases in women, compared with 77.4% in men. Sensitivity for advanced precancerous lesions was also lower in women (20.2% versus 25.8%). The difference was particularly pronounced for proximal CRC, where sensitivity was 50.0% in women and 80.8% in men. Women also had lower fecal hemoglobin concentrations, which may help explain the detection gap.
Investigators explored sex-specific thresholds to balance sensitivity and specificity. At thresholds designed to achieve 95% specificity, CRC sensitivity remained lower in women (63.3% versus 77.1%), although the difference was no longer statistically significant. Matching men’s CRC sensitivity in women would require lowering the threshold to 12 ng/mL, but specificity would fall to 75.7%. The analysis used a single FIT brand and test application, limiting generalizability.