Arch Iran Med. 2017;20(12):726-733.
PMID: 29664311
Scopus id: 85044336283
  Abstract View: 515
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Original Article

Feasibility of Colon Cancer Screening by Fecal Immunochemical Test in Iran

Hamideh Salimzadeh 1, Faraz Bishehsari 2, Catherine Sauvaget 3, Mohammad Amani 1, Gholamreza Hamzehloo 4, Ali Nikfarjam 4, Shahin Merat 1, Alireza Delavari 1 * , Reza Malekzadeh 1

1 Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA
3 Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
4 Health’s Deputy, Tehran University of Medical Sciences, Tehran, Iran
Corresponding Author: Alireza Delavari, MD; Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, P. O. Box: 14117-13135 Tehran, Iran. Tel: +98 -21- 82415219, Fax: +98 -21-82415400 Email:


Background: Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no mass screening for the disease yet. We aimed to measure the feasibility of a pilot CRC screening program based on fecal immunochemical test (FIT) in Iranian population and the implications for scaling-up at the national level.

Methods: A single quantitative FIT was offered by health navigators to individuals aged between 45 and 75 years in primary health centers in rural and urban areas in Tehran. Participants who had a positive FIT were referred for colonoscopy.

Results: A total of 1044 asymptomatic average-risk individuals were enrolled. The mean age (SD) was 54.1 ± 7.0 years and nearly 63.0% (n = 657) were female. Only a small fraction of the participants had a prior screening practice (2.2%) and were aware of colon cancer (13.7%). In sum, 1002 returned the FIT kit, of whom the stool sample was unsatisfactory for testing in six participants (0.6%). The FIT uptake was 96.0%, positivity rate was 9.1% and the detection rates were 11.9% for adenomas and 7.1% for advanced adenomas. No cancer was detected. The positive predictive value (PPV) of the FIT was about 17% for any colonic neoplasms.

Conclusion: This is the first study that reports minimal quality metrics within a CRC screening process. FIT modality as a test of choice for colon cancer screening in average-risk people is a safe and highly acceptable method of screening in Iranian people. The results of the current study may not be limited to Iranians, and could have implications to other developing countries with similar trends of CRC epidemic.

Cite this article as: Salimzadeh H, Bishehsari F, Sauvaget C, Amani M, Hamzehloo G, Nikfarjam A, et al. Feasibility of colon cancer screening by fecal immunochemical test in Iran. Arch Iran Med. 2017;20(12):726–733.
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Submitted: 31 Jul 2017
Accepted: 22 Nov 2017
First published online: 01 Dec 2017
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