LAUSR

for hemoglobin (FIT) is the main pillar of colorectal cancer (CRC) screening programs. The age range targeted by these programs, typically ≥50 years, corresponds to the age range in which cardiovascular morbidities are increasingly prevalent. Given that CRC and cardiovascular disease share several risk factors, those with cardiovascular disease are an important target group of CRC screening. This includes patients treated with oral anticoagulants (OACs), which are indicated for the prevention and treatment of thromboembolic disease and the prevention of ischemic stroke in patients with atrial fibrillation. It is known for both types of OAC (i. e. vitamin K antagonists [VKAs] and direct oral anticoagulants [DOACs]) that they increase the risk of gastrointestinal (GI) bleeding. This raises the question of whether or not OACs have an impact on FIT screening. This impact could be negative and/or positive. “Negative” refers to the concern that anticoagulation therapy may increase the chances of a false-positive test result, thereby decreasing the positive predictive value (PPV) of FIT. “Positive” refers to the possibility that OACs might cause minor bleeding from colorectal lesions and therefore unmask them, rendering them detectable through occult blood testing. An intriguing paper published in the current issue of Endoscopy provides new insights into this research question [1]. It reports on a cross-sectional study conducted in the context of the first round of the Danish CRC screening program (2014–2016). Available data included information on FIT participation, antithrombotic treatment before FIT testing, the FIT result, use of follow-up colonoscopy after a positive FIT, and the findings at follow-up colonoscopy, as well as age, sex, and the Charlson co-morbidity index. Overall, 884036 people aged 50–74 years were invited for FIT screening, of whom 551 570 people (62.4%) participated. Other studies on this topic often used the old guaiac test rather than FIT or had a substantially smaller sample size. What did this study show with regard to, first, the false-positive test results and the PPV? Among people receiving any antithrombotic treatment, 11.8% tested positive, as compared with 6% among people not receiving antithrombotic treatment. Considering those patients who were using only one Oral anticoagulants and fecal immunochemical tests for hemoglobin: do they go together?