{"entity":{"id":"idea-prev-fit-risk-adapted-thresholds","kind":"idea","name":"Personalised stool-test cut-offs by age, sex and prior results","aka":[],"tldr":"Bowel screening uses one blood-in-stool threshold for everyone. Setting it by age, sex and the person's previous results would find more cancers with the same number of colonoscopies.","summary":"Bowel screening applies one blood-in-stool threshold to everyone, so this idea sets FIT cut-offs and intervals by age, sex and prior results: people with low prior FIT move to three-yearly screening and those with high sub-threshold values are recalled in a year. FIT haemoglobin concentration and previous FIT values strongly predict future advanced neoplasia, and colonoscopy capacity rather than FIT cost is the binding constraint, so risk adaptation should find more cancers with the same number of colonoscopies. The test is a randomised evaluation within a national programme such as the Netherlands with a four-year endpoint. At early-clinical maturity it addresses the bottlenecks The hardest cancers are found late and Overdiagnosis and false alarms.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (The hardest cancers are found late): Crosby et al., Early detection of cancer (Science 2022)","url":"https://doi.org/10.1126/science.aay9040"}],"tags":[],"related":[],"cancers":["colorectal"],"sections":["early-detection"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-overdiagnosis"],"keyPapers":["paper-crosby-science"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Risk-adapted FIT increases advanced neoplasia detected per colonoscopy by at least 20% and reduces interval cancers by at least 15% at constant colonoscopy capacity.","rationale":"Colonoscopy capacity, not FIT cost, is the binding constraint; modelling from the Dutch and Scottish programmes supports it.","test":"Randomised evaluation within a national programme (e.g. the Netherlands) with a four-year endpoint.","maturity":"early-clinical","actor":"policy","cost":"small","horizonYears":4},"route":"/ideas/idea-prev-fit-risk-adapted-thresholds/","neighbours":{"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"paper":[{"id":"paper-crosby-science","kind":"paper","name":"Early detection of cancer","route":"/key-papers/paper-crosby-science/"},{"id":"paper-minnesota-fobt-nejm-1993","kind":"paper","name":"Minnesota trial: a yearly stool blood test cuts bowel cancer deaths by a third","route":"/key-papers/paper-minnesota-fobt-nejm-1993/"},{"id":"paper-nordicc-nejm-2022","kind":"paper","name":"NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected","route":"/key-papers/paper-nordicc-nejm-2022/"}],"technology":[{"id":"multitarget-stool-rna-test","kind":"technology","name":"Multitarget stool RNA test (ColoSense)","route":"/technologies/multitarget-stool-rna-test/"}]}}