FIT-Based Screening: Maximising Yield, Minimising Waste
The demand question, lower-GI edition — reframed as policy, because thresholds are where health systems quietly decide how much capacity is spent well. The most cancer per colonoscopy — and every colonoscopy not wasted is capacity, money and carbon returned to a patient who needs it.
Running order (indicative)
- Head
- Dr Roland Valorianchors the studio throughout
- Talk 1
- Prof Matthew RutterTwo Weeks, Not Eight Months: FIT in the Symptomatic Pathway
- Talk 2
- Prof Michael BretthauerFrom 20 to 120: The Policy Decisions Hiding Inside a FIT Threshold
- Talk 3
- Dr John AndersonScreening at 45, and the Patient Who Is Always Positive
- Live case
- Dr Barbara BastiaansenDr Manmeet MatharooFIT-positive screening colonoscopy — yield & quality in the screening setting
- Discussion
- Allremaining session time
The session, as written
Lecture 1 — Two weeks, not eight months: FIT in the symptomatic pathway. (Rutter). The British experience of FIT-guided triage for symptomatic patients — expediting the ones who matter within a fixed colonoscopy resource — and whether the single most exportable idea in this programme transfers to Europe.
Lecture 2 — From 20 to 120: the policy decisions hiding inside a FIT threshold. (Bretthauer). Screening thresholds vary six-fold worldwide. Sharper prognostication by adding age, sex, smoking and alcohol; interval policy after a negative colonoscopy — and the Dutch data showing that post-negative risk is mostly the quality of the index examination. The day's quality thread, pulled through its screening session.
Lecture 3 — Screening at 45, and the patient who is always positive. (Anderson, short intervention). The American 45 debate, and the recurrent FIT-positive — proctitis, IBD, anticoagulants — the subgroups where the standard screening answer stops making sense.
Live case — the FIT-positive colonoscopy. A screening examination live, with the yield-versus-quality argument running through it; scenario votes (scope, repeat FIT, image, reassure) carried in the discussion.
