Benefits of switching from guaiac-based faecal occult blood to faecal immunochemical testing: experience from the Wallonia–Brussels colorectal cancer screening programme



Faecal immunochemical tests (FITs) have replaced guaiac-based faecal occult blood test (gFOBTs) in several colorectal cancer (CRC) screening programmes. We aimed to evaluate the benefits of this transition based on the Wallonia–Brussels-organised CRC screening programme.


A total of 1,569,868 individuals aged 50–74 years, who were invited to screening during 2009–2017, were studied by linking their screening records with insurance, pathology and cancer data in the Belgian Cancer Registry. We compared neoplasm detection rates and positive predictive values (PPVs) of gFOBT and FIT at 15 µg haemoglobin per gram cut-off in screen-naive individuals. We furthermore examined the incidence rates of interval cancer in gFOBT- and FIT-based screening programme.


Advanced neoplasms were detected less frequently by gFOBT (0.8%) than by FIT (1.3%), with a difference of 0.5% (P < 0.01). PPVs were lower for gFOBT (15.1%) than for FIT (21.7%) for advanced neoplasms (difference 6.6%, P < 0.01). Compared to participants with negative gFOBT, those with negative FIT were 77% less likely to develop interval cancer (incidence rate ratio 0.23, 95% confidence interval 0.16–0.33).


Our study demonstrated that in an organised CRC screening programme, replacing gFOBT with FIT improved neoplasm detection rate and substantially reduced interval cancer incidence.

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We sincerely thank all the members of the Walloon screening organisation for their efforts on the CRC screening programme implementation. We also thank the Walloon authority Agency for a life of quality for supporting the Walloon CRC screening programme. We gratefully thank all the registration teams of the BCR for the data collection and management. We sincerely thank Ms. Petra Denolf at the BCR for the data preparation for our study.

Author information

Planning the study: F.G., I.D.B. and H.B. Data collection: I.D.B., J.F., M.C., M.P. and L.V.E. Statistical analysis and results interpretation: F.G., I.D.B. and H.B. Drafting the manuscript: F.G. Revision of the manuscript: I.D.B. and H.B. Critical reading and approving the manuscript: all authors.

Correspondence to Hermann Brenner.

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Ethics approval and consent to participate

Approval for the implementation of the Wallonia–Brussels-organised CRC screening programme and data linkage with the IMA and BCR databases for analyses was provided by the Sectoral Committee of Social Security and Health with reference number 16/019.

Consent to publish

All participants within the screening programme completed informed consent, declaring that personal information can be used for scientific research to evaluate and improve the screening programme. All analyses were based on the anonymised data and performed within the secured BCR environment, strictly in line with all applicable privacy restrictions. No identifying patient details, images or videos are used in this manuscript.

Data availability

Additional summary tables and sensitivity analyses are available upon reasonable request from the corresponding author.

Competing interests

The authors declare no competing interests.

Funding information

The analyses for this project were supported by grants from the German Cancer Aid (No. 70112095) and the German Federal Ministry of Education and Research (No. 01GL1712).

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Guo, F., De Brabander, I., Francart, J. et al. Benefits of switching from guaiac-based faecal occult blood to faecal immunochemical testing: experience from the Wallonia–Brussels colorectal cancer screening programme. Br J Cancer 122, 1109–1117 (2020). https://doi.org/10.1038/s41416-020-0754-5

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