The COLONPREV randomized trial compared invitations to biennial FIT versus a one-time colonoscopy for colorectal cancer screening across 53,000 people in Spain. After 15 years, mortality from CRC was virtually identical between groups. While colonoscopy detected more advanced precancerous polyps, FIT achieved higher participation and similar cancer outcomes.
But here’s the twist: only about one-third of invitees actually got screened — far below the 80% uptake goal set by the U.S. National Colorectal Cancer Roundtable. That low participation clouds the real-world meaning of the results.
So, does this trial reaffirm colonoscopy as the “gold standard,” or does it bolster the case for organized FIT-based screening programs in health systems where cost and uptake are barriers? The debate is far from over.