Non-neoplastic findings at colonoscopy after positive faecal occult blood testing: Data from the English Bowel Cancer Screening Programme

Abstract

Background: The aim of the English Bowel Cancer Screening Programme (BCSP) is to diagnose early colorectal cancer and advanced adenomas. However, other findings are also reported at screening colonoscopy. Small studies demonstrate findings other than cancer or adenomas (non-neoplastic findings (NNF)) in 11-25%. Objectives and setting: Describe the frequency and nature of NNF within the BSCP. Methods: Data were obtained from the BCSP national database for all individuals undergoing colonoscopic investigation after positive faecal occult blood testing between August 2006 and November 2011. Data included demographics, smoking status, neoplastic findings and NNF. Results: 121728 colonoscopies were analysed. 51 NNF were found in 26251 cases (21.6%). Diverticular disease (18875 cases) and haemorrhoids (7011) were the most frequently reported. Inflammatory bowel disease (IBD) was reported in 2152 cases. Individuals with a neoplastic diagnosis were less likely to have an NNF than those without (19.8% v 24.4%, p < 0.001). After adjustment for confounding using multivariable analysis, older age was still associated with a small but statistically significant risk of NNF. Conclusions: The BCSP generates a significant volume of NNF. A small proportion of individuals were found to have inflammatory bowel disease (IBD) -an important diagnosis with implications for long-term management. BCSP participants should be aware that findings other than neoplasia may be detected and the relevance of these findings to that individual is not known. Reporting of NNF varies between colonoscopists, and potential underreporting is a limitation of this study. Further study is required to establish the impact of NNF on primary and secondary care.

Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

“…Colonoscopy results for findings other than polyps, adenomas, and cancer were not collected in this study. Because we did not consider new findings of gastrointestinal disease discovered during the follow‐up colonoscopy, the true prevalence is expected to be higher …”

“…Because we did not consider new findings of gastrointestinal disease discovered during the follow-up colonoscopy, the true prevalence is expected to be higher. 44 Although smoking has been consistently associated with false positivity (ORs from 1.3 to 1.7), 21,23,24 we saw no association. Smoking history was determined from social history fields in the EHR, and a substantial proportion (10%) were missing data on smoking status.…”

The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations

“…Chapter 7 Synthesis C urrent UK guidelines recommend 3-yearly surveillance for patients classified as being at IR based on characteristics of adenomas that were found at baseline colonoscopy. The IR group represents 17% of people testing positive in the NHS BCSP, 36 and around 40% of patients with adenomas in the hospital data set in this study, with consequent demand on colonoscopy resources, yet the heterogeneity of the group in terms of cancer risk and surveillance requirements has not been investigated. We therefore sought to examine the effect of surveillance interval length on detection rates of AA and CRC in patients attending follow-up after removal of IR adenomas, and of surveillance colonoscopy on CRC risk after baseline.…”

“…According to this same source, 909,839 usable kits were returned in 2011, which implies a total of 20,097 individuals testing positive and requiring further investigation. Assuming that 17% of these patients are classed as having IR adenomas, 36 this would suggest an incident population of around 3417 patients each year. However, the lifetime incremental cost of the alternative surveillance options relative to a policy of no adenoma surveillance is small (-£59 to £1166); hence, it is likely that the overall impact of alternative adenomas surveillance options on NHS expenditures each year will also be relatively small, and may even produce small cost-savings depending on which option is pursued.…”

“…25 There is evidence of both over-and underutilisation of colonoscopy, and a potential for more efficient allocation of endoscopy resources. 35 The IR group comprises nearly 20% of those subjects participating in the BCSP who undergo colonoscopy for a positive test, 36 and nearly half of adenoma patients, 2 yet no study has yet systematically examined whether or not there is heterogeneity in risk among patients who are currently offered 3-yearly surveillance. We sought to address the unanswered questions surrounding the current IR group surveillance strategy, that is:…”