Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM)

This study is currently recruiting participants. (see Contacts and Locations)
Verified July 2015 by VA Office of Research and Development
Information provided by (Responsible Party):
VA Office of Research and Development Identifier:
First received: November 9, 2010
Last updated: July 23, 2015
Last verified: July 2015

Colorectal cancer (CRC) is currently the second most common cause of cancer death in the United States, and one of the most preventable cancers. It has been shown in several randomized controlled trials that screening using fecal occult blood testing (FOBT) reduces CRC mortality by 13-33%. While there is strong consensus amongst experts regarding the value of CRC screening, the best approach to screening is not clear. Of the widely recommended modalities, FOBT and colonoscopy are the most commonly used within the United States. FOBT is inexpensive, non-invasive, and its use as a screening tool is supported by the highest quality evidence (i.e. randomized controlled trials). Moreover, newer FOBT, such as fecal immunochemical tests or FITs, have advantages over conventional FOBT in terms of both test characteristics and ease of use that make them quite attractive as a population-based screening tool.

While colonoscopy is invasive and has higher up-front risks and costs than FOBT, it does afford the opportunity to directly assess the colonic mucosa and is widely believed to be the best test to detect colorectal cancer. In addition, colonoscopy allows for the detection and removal of colorectal adenomas -a well recognized colorectal cancer precursor. There is indirect evidence that suggests colonoscopy is effective in reducing colorectal cancer mortality, but to date, no large clinical trials have been completed to support this assumption. While colonoscopy use is increasing, data is emerging that colonoscopy may not be as effective as previously believed. Prior support for colonoscopy as a screening test relied upon effectiveness estimates that now appear to be overly optimistic. Given the invasive nature of colonoscopy, the associated small, but real risk of complications, and dramatically higher costs than other screening tests, it is especially important to determine the true comparative effectiveness of colonoscopy relative to other proven non-invasive options.

The investigators propose to perform a, large, simple, multicenter, randomized, parallel group trial directly comparing screening colonoscopy with annual FIT screening in average risk individuals. Our hypothesis is that colonoscopy will be superior to FIT in the prevention of colorectal cancer mortality measured over 10 years. Individuals will be enrolled if they are currently eligible for CRC screening (e.g. no colonoscopy in the past 10 years and no FOBT in the past 1 year) and are between 50 and 75 years of age. The investigators will exclude individuals for whom colonoscopy is indicated (e.g. signs or symptoms of CRC, first degree family member with CRC, personal history of colorectal neoplasia or inflammatory bowel disease).

All participants will complete baseline demographic, medication, and lifestyle questionnaires (e.g. diet, non-steroidal anti-inflammatory use, frequency of exercise) prior to randomization in a 1:1 ratio to either screening colonoscopy or annual FIT screening (Figure 1). Those testing positive by FIT will undergo evaluation to determine appropriateness for colonoscopy. Screening will be performed in a manner consistent with the currently accepted standard of care in order to determine the comparative effectiveness of the two screening strategies. Participants will be surveyed annually to determine if they have undergone colonoscopy or been diagnosed with CRC.

The primary study endpoint will be CRC mortality within 10 years of enrollment. The secondary endpoints are (1) the incidence of CRC within 10 years of enrollment and (2) major complications of colonoscopy. Mortality will be determined through queries of the VA Vital Status File. Cause of death will be determined primarily using death certificates from the National Death Index-Plus database, augmented by adjudication of medical records for known CRC cases where CRC is not listed as a cause of death on the death certificate. We postulate that screening colonoscopy will result in a 40% reduction in CRC mortality over 10 years relative to annual FIT screening. Using a log-rank test with a 2-sided test of significance, =0.05, a sample size of 50,000 participants will be required to test the primary hypothesis with 82% power, assuming a 1% annual rate of crossover from FIT to colonoscopy and a 0.5% annual rate of loss to follow-up. The planned study duration is 12.5 years with 2.5 years of recruitment and 10 years of follow-up for all enrolled participants.

Condition Intervention
Colorectal Cancer
Procedure: Colonoscopy
Procedure: FIT

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Diagnostic
Official Title: CSP #577 - Colonoscopy vs. Fecal Immunochemical Testing in Reducing Mortality From Colorectal Cancer

Resource links provided by NLM:

Further study details as provided by VA Office of Research and Development:

Primary Outcome Measures:
  • The primary outcome is colorectal cancer mortality. [ Time Frame: 10 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 50000
Study Start Date: April 2012
Estimated Study Completion Date: September 2027
Estimated Primary Completion Date: September 2027 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Arm 1
Colonoscopy (one time screening)
Procedure: Colonoscopy
One time screening Colonoscopy to screen for colorectal cancer
Arm 2
FIT (annually)
Procedure: FIT
Annual FIT testing


Ages Eligible for Study:   50 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Male and female adults aged 50-75 years of age
  • Veteran
  • Able to provide informed consent

Exclusion Criteria:

  • Symptoms of lower gastrointestinal tract disease warranting colonoscopic evaluation, including:

    • More than one episode of rectal bleeding within the past 6 months
    • Documented iron deficiency anemia
    • Significant documented unintentional weight loss (>10% of baseline weight) over 6 months
  • Family history of CRC in a first degree relative at any age
  • Prior history of colonic disease including:

    • Inflammatory bowel disease (e.g. ulcerative colitis or Crohn's disease)
    • One or more colorectal neoplastic polyps (i.e. adenomas)
    • Colorectal cancer
  • Prior history of colonic resection
  • Prior colonic examination, including:

    • Colonoscopy within the past 9.5 years
    • Sigmoidoscopy within the past 5 years
    • Barium enema within the past 5 years
    • CT colonography within the past 5 years
  • gFOBT or FIT in the past 10 months
  • Stool DNA test within the past 3 years
  • Pregnancy
  • Prisoner
  • Significant comorbidity that would preclude benefit from screening or pose significant risk for the performance of colonoscopy (e.g. severe lung disease, end-stage renal disease, end-stage liver disease, severe heart failure, recent diagnosis of cancer (with the exception of non-melanoma skin cancer))
  • Participation in a concurrent interventional study
  • Likely inability to track the individual over time (e.g. no permanent address at the time of screening for study entry)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01239082

Contact: Robert F Wallace, ScD (203) 932-5711 ext 3776
Contact: Lynn M Tommessilli (203) 932-5711 ext 3769

  Hide Study Locations
United States, Arizona
Phoenix VA Health Care System Carl T. Hayden VA Medical Center, Phoenix, AZ Recruiting
Phoenix, Arizona, United States, 85012
Contact: Charles H Beymer, MD    602-277-5551 ext 7795   
United States, Arkansas
Central Arkansas VHS John L. McClellan Memorial Veterans Hospital, Little Rock, AR Recruiting
Little Rock, Arkansas, United States, 72205-5484
Contact: Kurt H Hagedorn, MD    501-257-5950   
United States, California
VA Central California Health Care System, Fresno, CA Recruiting
Fresno, California, United States, 93703
Contact: Helen W Wong, MD    559-225-6100 ext 5069   
VA Loma Linda Healthcare System, Loma Linda, CA Recruiting
Loma Linda, California, United States, 92357
Contact: Christian S Jackson, MD    909-825-7084 ext 1184   
VA Long Beach Healthcare System, Long Beach, CA Recruiting
Long Beach, California, United States, 90822
Contact: Mazen Jamal, MD    562-826-5628   
VA San Diego Healthcare System, San Diego, CA Recruiting
San Diego, California, United States, 92161
Contact: Samuel B Ho, MD    858-642-3280   
VA Greater Los Angeles Healthcare System, West Los Angeles, CA Recruiting
West Los Angeles, California, United States, 90073
Contact: Joseph R Pisegna, MD    310-268-3578   
United States, Colorado
VA Eastern Colorado Health Care System, Denver, CO Recruiting
Denver, Colorado, United States, 80220
Contact: Dennis J Ahnen, MD    303-399-8020 ext 3127   
United States, Connecticut
VA Connecticut Healthcare System West Haven Campus, West Haven, CT Recruiting
West Haven, Connecticut, United States, 06516
Contact: Petr Protiva, MD    203-932-5711 ext 2210   
United States, Florida
North Florida/South Georgia Veterans Health System, Gainesville, FL Recruiting
Gainesville, Florida, United States, 32608
Contact: Shahnaz Sultan, MD    352-376-1611 ext 6574   
Miami VA Healthcare System, Miami, FL Recruiting
Miami, Florida, United States, 33125
Contact: Paul A Feldman, MD    305-575-7000 ext 3162   
Orlando VA Medical Center, Orlando, FL Recruiting
Orlando, Florida, United States, 32803
Contact: Christopher Lopez, MD    321-397-6643   
James A. Haley Veterans' Hospital, Tampa, FL Recruiting
Tampa, Florida, United States, 33612
Contact: Jeffrey Gill, MD    813-972-2000 ext 6237   
United States, Georgia
Atlanta VA Medical and Rehab Center, Decatur, GA Recruiting
Decatur, Georgia, United States, 30033
Contact: Mohammad Wehbi, MD    404-321-6111 ext 6782   
United States, Hawaii
VA Pacific Islands Health Care System, Honolulu, HI Terminated
Honolulu, Hawaii, United States, 96819-1522
United States, Illinois
Jesse Brown VA Medical Center, Chicago, IL Recruiting
Chicago, Illinois, United States, 60612
Contact: Lyn Sue Kahng, MD    312-569-6193   
United States, Indiana
Richard L. Roudebush VA Medical Center, Indianapolis, IN Recruiting
Indianapolis, Indiana, United States, 46202-2884
Contact: Thomas F Imperiale, MD    317-988-2223   
United States, Maryland
Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD Recruiting
Baltimore, Maryland, United States, 21201
Contact: Erik von Rosenvinge, MD    410-605-7000 ext 5260   
United States, Massachusetts
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA Recruiting
Boston, Massachusetts, United States, 02130
Contact: Gyorgy Baffy, MD    857-364-4327   
United States, Michigan
VA Ann Arbor Healthcare System, Ann Arbor, MI Recruiting
Ann Arbor, Michigan, United States, 48113
Contact: Philip Schoenfeld, MD    734-845-5795   
John D. Dingell VA Medical Center, Detroit, MI Recruiting
Detroit, Michigan, United States, 48201
Contact: Fadi Antaki, MD    313-576-3389   
United States, Minnesota
Minneapolis VA Health Care System, Minneapolis, MN Recruiting
Minneapolis, Minnesota, United States, 55417
Contact: Aasma Shaukat, MD    612-467-4100   
United States, Missouri
Kansas City VA Medical Center, Kansas City, MO Recruiting
Kansas City, Missouri, United States, 64128
Contact: Sharma Prateek, MD    818-861-4711 ext 56737   
St. Louis VA Medical Center John Cochran Division, St. Louis, MO Recruiting
St Louis, Missouri, United States, 63106
Contact: Jill E Elwing, MD    314-289-6434   
United States, New Jersey
East Orange Campus of the VA New Jersey Health Care System, East Orange, NJ Terminated
East Orange, New Jersey, United States, 07018
United States, New York
Manhattan Campus of the VA NY Harbor Healthcare System, New York, NY Withdrawn
New York, New York, United States, 10010
Northport VA Medical Center, Northport, NY Recruiting
Northport, New York, United States, 11768
Contact: Robert D Shaw, MD    631-261-4400 ext 2832   
United States, North Carolina
Durham VA Medical Center, Durham, NC Terminated
Durham, North Carolina, United States, 27705
Salisbury W.G. (Bill) Hefner VA Medical Center, Salisbury, NC Terminated
Salisbury, North Carolina, United States, 28144
United States, Ohio
Louis Stokes VA Medical Center, Cleveland, OH Terminated
Cleveland, Ohio, United States, 44106
United States, Oklahoma
Oklahoma City VA Medical Center, Oklahoma City, OK Recruiting
Oklahoma City, Oklahoma, United States, 73104
Contact: William M Tierney, MD    405-456-1000   
United States, Oregon
Portland VA Medical Center, Portland, OR Recruiting
Portland, Oregon, United States, 97201
Contact: David Lieberman, MD    503-721-1062   
United States, Pennsylvania
Philadelphia MultiService Center, Philadelphia, PA Recruiting
Philadelphia, Pennsylvania, United States, 19106
Contact: Emily C Paulson, MD    215-823-5800 ext 6637   
United States, Rhode Island
Providence VA Medical Center, Providence, RI Recruiting
Providence, Rhode Island, United States, 02908
Contact: Kittichai Promrat, MD    401-273-7100 ext 2356   
United States, South Carolina
Wm. Jennings Bryan Dorn VA Medical Center, Columbia SC Withdrawn
Columbia, South Carolina, United States, 29209
United States, Tennessee
Memphis VA Medical Center, Memphis, TN Terminated
Memphis, Tennessee, United States, 38104
United States, Texas
VA North Texas Health Care System Dallas VA Medical Center, Dallas, TX Recruiting
Dallas, Texas, United States, 75216
Contact: William V Harford, MD    214-857-4132   
Michael E. DeBakey VA Medical Center, Houston, TX Recruiting
Houston, Texas, United States, 77030
Contact: Rhonda A Cole, MD    713-794-7274   
United States, Utah
VA Salt Lake City Health Care System, Salt Lake City, UT Recruiting
Salt Lake City, Utah, United States, 84148
Contact: Mae F Go, MD    801-582-1565 ext 44833   
United States, Vermont
White River Junction VA Medical Center and Regional Office, White River Junction, VT Recruiting
White River Junction, Vermont, United States, 05009-0001
Contact: Heiko Pohl, MD    802-295-9363 ext 5595   
United States, Virginia
Hunter Holmes McGuire VA Medical Center, Richmond, VA Recruiting
Richmond, Virginia, United States, 23249
Contact: Juan Diego Baltodano, MD    804-675-5021   
United States, Washington
VA Puget Sound Health Care System Seattle Division, Seattle, WA Recruiting
Seattle, Washington, United States, 98108
Contact: Jason A Dominitz, MD MHS    206-764-2285   
Contact: Douglas J Robertson, MD MPH    (802) 295-9363 ext 6062   
Study Chair: Jason A. Dominitz, MD MHS         
United States, West Virginia
Clarksburg Louis A. Johnson VA Medical Center, Clarksburg, WV Recruiting
Clarksburg, West Virginia, United States, 26301
Contact: Riaz Cassim, MD    304-623-7617   
United States, Wisconsin
William S. Middleton Memorial Veterans Hospital, Madison, WI Recruiting
Madison, Wisconsin, United States, 53705
Contact: Adnan Said, MD    608-213-4070 ext 17002   
Puerto Rico
VA Caribbean Healthcare System, San Juan, PR Recruiting
San Juan, Puerto Rico, 00921
Contact: Doris H Toro, MD    787-641-3669   
Sponsors and Collaborators
VA Office of Research and Development
Study Chair: Jason A. Dominitz, MD MHS VA Puget Sound Health Care System Seattle Division, Seattle, WA
Study Chair: Douglas J Robertson, MD MPH White River Junction VA Medical Center, White River Junction, VT
  More Information

Responsible Party: VA Office of Research and Development Identifier: NCT01239082     History of Changes
Other Study ID Numbers: 577
Study First Received: November 9, 2010
Last Updated: July 23, 2015
Health Authority: United States: Federal Government

Additional relevant MeSH terms:
Colorectal Neoplasms
Colonic Diseases
Digestive System Diseases
Digestive System Neoplasms
Gastrointestinal Diseases
Gastrointestinal Neoplasms
Intestinal Diseases
Intestinal Neoplasms
Neoplasms by Site
Rectal Diseases processed this record on November 27, 2015