Berry E, et al. - In this prospective study involving 17,017 uninsured patients (aged 50 to 64 years), researchers explored whether the reduction of the cut-off hemoglobin concentration for designation as an abnormal fecal immunochemical test (FIT) result increased the detection of advanced neoplasia in the mailed outreach program. Investigators discovered that lowering the abnormal FIT result cut-off value (to ≥ 10 μg hemoglobin/g feces) could boost detection of advanced neoplasia, but doubled the percentage of patients needing a diagnostic colonoscopy. They observed that most patients with colorectal cancer or advanced adenoma had hemoglobin concentrations of 20 or more μg/g feces. To optimize colorectal cancer detection and prevention, health systems using quantitative FITs should consider reducing the abnormal cut-off value if colonoscopy capacity permits.