Optimizing colonoscopy-based colorectal cancer screening by low-barrier, low-threshold pretesting.

This study evaluates an innovative “gateopener” colonoscopy-based screening strategy for colorectal cancer (CRC) that uses a preliminary fecal immunochemical test (FIT) with a lower positivity threshold to better select individuals for colonoscopy.

Using a validated simulation model, the authors compared gateopener screening at various low hemoglobin cut-offs to conventional FIT and colonoscopy screening.

Key findings include:

• Gateopener screening, especially at cut-offs of 3 to 6 μg/g feces, significantly outperformed conventional colonoscopy by preventing 16%–72% more CRC cases and more than doubling prevented deaths over 10 years.
• Compared to biennial FIT, gateopener screening also prevented substantially more cases and deaths.
• Lower cut-offs enhanced effectiveness but increased colonoscopy demand.
• Intermediate thresholds provided a balance between resource use and outcomes.

Overall, gateopener screening demonstrated superior effectiveness in reducing CRC incidence and mortality, warranting pilot studies to assess real-world feasibility.