Optimizing Initial Screening for Colorectal Cancer Detection with Adherence Behavior.

This article focuses on optimizing the fecal immunochemical test (FIT) cutoff values in two-stage colorectal cancer (CRC) screening programs to improve detection effectiveness and manage colonoscopy demand, incorporating individuals' adherence behavior. Using an information design model based on Bayesian persuasion and information avoidance, calibrated with a nationwide survey of 3,920 Singapore residents aged 50 and above, the study finds that the current FIT cutoff in Singapore (20 μg/g) is suboptimal. Raising the cutoff to 39 μg/g in a two-sample FIT scheme could detect 21% more CRC and polyp cases, reduce colonoscopies by 27%, lower lifetime CRC risk by 11%, and save significant healthcare costs. The research also shows that reporting exact fecal-hemoglobin concentrations (continuous FIT) can maximize detection effectiveness, while a single cutoff maximizes follow-up adherence, and that customized cutoffs for subpopulations based on demographic factors further improve outcomes. These findings support adopting quantitative FIT kits with tailored cutoffs to enhance CRC screening programs, though local calibration is necessary for broader application.