Colorectal cancer after negative colonoscopy in fecal immunochemical test-positive participants from a colorectal cancer screening program

Rivero‐Sánchez, Liseth; Grau, Jaume; Augé, Josep M.; Moreno, Lorena; Pozo, Àngels; Serradesanferm, Anna; Díaz, Mireia; Carballal, Sabela; Sánchez, Ariadna; Moreira, Letícia; Balaguer, Francesc; Pellisé, María; Castells, Antoni

doi:10.1055/a-0650-4296

Cited by 18 publications

(14 citation statements)

References 36 publications

(49 reference statements)

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“…32 In a recent study from Spain, 5% of those with positive FIT and negative colonoscopy had lesions detected during 42-76 months of follow-up, one third of them were significant neoplasms mostly located in the colon and rectum. 33 In a recent study from the Netherlands hemoglobin concentrations just below the FIT cutoff were highly predictive of later development and detection of advanced colorectal neoplasms. 34 Most likely the presence of early stage neoplasms accounted for a large proportion of baseline FIT results just below the cutoff.…”

Section: Discussionmentioning

confidence: 96%

Factors associated with false‐positive fecal immunochemical tests in a large German colorectal cancer screening study

Amitay

Ćuk

Niedermaier

et al. 2019

Intl Journal of Cancer

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In recent years fecal immunochemical tests (FITs) have been offered as a primary screening test for colorectal cancer (CRC) in a growing number of countries. Our study aims to identify factors associated with apparently false‐positive results of FITs. In this cross‐sectional study within the German population‐based screening colonoscopy program, participants were invited to provide a stool sample for FIT prior to colonoscopy. Four thousand six hundred and fifty six participants aged 50–79 years with no known history of CRC or inflammatory bowel disease (IBD) and no findings of neoplasms at screening colonoscopy were included in the current analyses. Main outcome measures were rates and factors associated with apparently false‐positive FIT results. Apparently false‐positive FIT results were found for 378 participants (8.1%). Male sex (OR = 1.30, 95%CI 1.03, 1.62), age ≥65 years (OR = 1.27, 95%CI 1.01, 1.59), a BMI ≥30 kg/m2 (OR = 1.81, 95%CI 1.36, 2.40), current smoking (OR = 1.63, 95%CI 1.18, 2.25), use of aspirin (OR = 1.36, 95%CI 1.02, 1.82) and a new diagnosis of IBD (OR = 9.13, 95%CI 2.18, 38.19) or other non‐neoplastic findings (OR = 1.86, 95%CI 1.37, 2.51) at screening colonoscopy were independently associated with significantly increased odds of a positive FIT. Although considered false positive in the context of CRC screening, the identified factors associated with apparently false‐positive FIT results are known risk factors for and may point to conditions other than colorectal neoplasms that may be potential sources of gastrointestinal bleeding, potentially requiring further medical follow up.

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Section: Discussionmentioning

confidence: 96%

Factors associated with false‐positive fecal immunochemical tests in a large German colorectal cancer screening study

Amitay

Ćuk

Niedermaier

et al. 2019

Intl Journal of Cancer

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“…Sometimes, patients present with FIT positivity after normal colonoscopy. In an observational population-based study, the incidence of developing CRC was 0.4% over a period of 4.7 years [13]. It is the author's opinion not to do FIT after a high quality normal colonoscopy as FIT can be positive due to other lesions in the gastrointestinal tract.…”

Section: Screening Programsmentioning

confidence: 99%

Colon Cancer: A Clinician’s Perspective in 2019

2020

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Colon cancer is a common preventable cancer. With the adoption of widespread colon cancer screening in the developed countries, the incidence and mortality of colon cancer have decreased in the targeted population. But unfortunately, the incidence and mortality of colorectal cancer (CRC) have been increasing over the last 25 years in the young adults below the age of 50. There is disparity in benefit, i.e. reduction in risk of death between right-sided and left-sided colon cancer by screening colonoscopy. The reason could be multifactorial and various measures have been taken to decrease this disparity. Although most of the screened populations are average risk individuals, a minority of the population have various risk factors for developing colon cancer and need to follow specific colon cancer screening guidelines. Gene mutations (adenomatous polyposis coli (APC), deleted in colon cancer (DCC), K-ras, p53, B-Raf proto-oncogene serine/threonine kinase (BRAF), mismatch repair genes) and microsatellite instability lead to the development of colon cancer. Although various non-invasive methods of colon cancer screening are now available, colonoscopy remains the gold standard of colon cancer screening and adenoma detection rate is now being used as the quality metrics in screening colonoscopy. Although Multi-Society Task Force (MSTF) and American College of Physicians (ACP) recommend initiating screening colonoscopy at age 50 years in all individuals except African Americans who should begin screening colonoscopy at age 45 years, the American Cancer Society (ACS) recommends initiating screening colonoscopy at age 45 years in all individuals irrespective of race and ethnicity. Low-volume split-dose prep has been found to be as effective as high-volume split-dose prep and more tolerable to patients with increased compliance. Boston bowel preparation scale is recommended to measure the quality of colon cleansing. CRC is curative if it is diagnosed at an early stage but various palliative treatment options (endoscopic, oncologic and surgical) are available in advanced stages of this cancer. Adequate number of lymph node assessment during surgery is essential in accurate staging of CRC. Checkpoint inhibitors have been found to have dramatic response and durable clinical benefit in dMMR/MSI-H metastatic CRC. Different genetic and immune-oncologic research trials are ongoing for early detection and better management of CRC.

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“…Post-colonoscopy colorectal cancer rates have been reported between 1 in 130 to 1 in 1,000 colonoscopies (32). However, the most comparable study is by Rivero-S anchez and colleagues (33) who found a rate of post-colonoscopy cancers of 0.8 per 1,000 person-years of follow-up after a negative colonoscopy. Differences in incidence rates may be partially attributed to a statistical variability due to small numbers and different lengths of follow-up.…”

Section: Discussionmentioning

confidence: 99%

False-Positive Results in a Population-Based Colorectal Screening Program: Cumulative Risk from 2000 to 2017 with Biennial Screening

Ibáñez‐Sanz¹,

Garcia²,

Milà³

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: The aim of this study was to estimate the cumulative risk of a false-positive (FP) result in a fecal occult blood test (FOBT) through 7 screening rounds and to identify its associated factors in a population-based colorectal cancer screening program.Methods: Retrospective cohort study, which included participants ages 50 to 69 years of a colorectal cancer screening program in Catalonia, Spain. During this period, 2 FOBTs were used (guaiac and immunochemical). A discrete-time survival model was performed to identify risk factors of receiving a positive FOBT with no high-risk adenoma or colorectal cancer in the follow-up colonoscopy. We estimated the probability of having at least 1 FP over 7 screening rounds.Results: During the period of 2000 to 2017, the cumulative FP risk was 16.3% (IC 95% : 14.6%-18.3%), adjusted by age, sex, and type of test. The median number of screens was 2. Participants who began screening at age 50 years had a 7.3% [95% confidence interval (CI), 6.35-8.51] and a 12.4% (95% CI, 11.00-13.94) probability of an FP with 4 screening rounds of guaiac-based test and immunochemical test, respectively. Age, the fecal immunochemical test, first screening, and number of personal screens were factors associated with an FP result among screenees.Conclusions: The cumulative risk of an FP in colorectal screening using FOBT seems acceptable as the colonoscopy, with its high accuracy, lengthens the time until additional colorectal screening is required, while complication rates remain low.Impact: It is useful to determine the cumulative FP risk in cancer screening for both advising individuals and for health resources planning.

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Colorectal cancer after negative colonoscopy in fecal immunochemical test-positive participants from a colorectal cancer screening program

Cited by 18 publications

References 36 publications

Factors associated with false‐positive fecal immunochemical tests in a large German colorectal cancer screening study

Factors associated with false‐positive fecal immunochemical tests in a large German colorectal cancer screening study

Colon Cancer: A Clinician’s Perspective in 2019

False-Positive Results in a Population-Based Colorectal Screening Program: Cumulative Risk from 2000 to 2017 with Biennial Screening

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