A community-based 2-arm cluster randomized trial to compare universal FIT testing versus target (risk assessment done) FIT testing for Early onset colorectal cancer (EOCRC) in India

Although traditionally regarded as a low-incidence region, India has experienced a rapid rise in EOCRC incidence in the last few years. The Delhi  State Cancer Institute recently reported that an astonishing 60% of their CRC patients were aged <50 years, with younger patients more often diagnosed at an advanced stage. In 2019 data from a separate center, the mean age of diagnosis among 970 CRC patients was 47.5 years, with 35% of newly diagnosed CRC patients being under the age of 40.1 This trend reflects global trends with most low- and middle-income countries experiencing a dramatic rise in EOCRC, mimicking that which began over a decade prior in high-income countries. Currently, there are no population-level screening guidelines for CRC in India, and it is unclear if data around efficacy and optimal screening age derived from Western countries can be extrapolated to India. Thus, the present juncture is an opportune time to initiate community- based trials in India to not only measure the rapid acceleration CRC incidence, but also identify effective strategies for intervention, including assessing the impact of population-based CRC screening.