Faecal immunochemical test after negative colonoscopy may reduce the risk of incident colorectal cancer in a population-based screening programme

Abstract

ObjectiveSubjects with a positive faecal immunochemical test (FIT) have a much higher likelihood of advanced neoplasms than the general population. Whether FIT-positive subjects with negative colonoscopy should receive subsequent FIT screening remain unclear.DesignSubjects with a negative colonoscopy after positive FIT in the first screening in the Taiwanese Colorectal Cancer (CRC) Screening Program 2004–2009 were followed until the end of 2014. CRC incidence was compared between those who did and did not receive subsequent FIT screening. Cox regression analysis was conducted, adjusting for major confounders to investigate whether subsequent FIT was associated with lower risk of incident CRC.ResultsThe study cohort was comprised of 9179 subjects who had negative diagnostic colonoscopy after positive FIT in 2004–2009, of whom 6195 received subsequent FIT during the study period. The CRC incidence (per 1000 person years) was 1.34 in those who received subsequent FIT and 2.69 in those who did not, with corresponding adjusted HR (aHR) of 0.47 (95% CI 0.31 to 0.71). Lower adenoma detection rate of diagnostic colonoscopy was associated with higher risk of incident CRC but became non-significant in multivariable analysis after adjustment for subsequent FIT. Higher baseline faecal haemoglobin concentration (FHbC, μg haemoglobin/g faeces) was associated with increased risk of incident CRC (reference: FHbC=20–39; aHR=1.93 (1.04–3.56), 0.95 (0.45–2.00), 2.26 (1.16–4.43) and 2.44 (1.44–4.12) for FHbC=40–59, 60–99, 100–149 and ≥150, respectively).ConclusionSubsequent FIT should be scheduled after negative colonoscopy to detect missed neoplasms and reduce the risk of incident CRC in a national FIT screening programme.

Comparison with first round findings of faecal haemoglobin concentrations and clinical outcomes in the second round of a biennial faecal immunochemical test based colorectal cancer screening programme

“…This is in keeping with our previous work that found a 3.8% risk of CRC in the second round of a gFOBT programme among those with a negative colonoscopy in the first round, 19 and with a study from the Taiwanese screening programme showing that amongst participants who had a negative colonoscopy those who underwent subsequent FIT were at lower risk of developing CRC than those who did not. 20 The CRC cases in both of our studies, as well as many in the Taiwanese study, would be considered to be post-colonoscopy colorectal cancers, 21 and the existence of these underlines the importance of continued screening.…”

To scope or not - the challenges of managing patients with positive fecal occult blood test after recent colonoscopy

“…Similarly, a study revealed CRC was diagnosed in 0.4% (3 of 740) patients with positive guaiac-FOBT within 28 mo after their index negative colonoscopy[ 16 ]. A recent study by Peng et al [ 17 ] reported that the incidence of CRC following a negative colonoscopy was significantly lower in patients who recommenced iFOBT as compared to those who did not (incidence: 1.34 vs 2.69 per 1000 person years; adjusted OR = 0.47). Notably, of those who undertook iFOBT screening, the incidence of CRC was highest in those who had their subsequent iFOBT between 1.5 to 3 years, as compared to those performed 5 years or more (1.46 vs 1.08 per 1000 person years).…”

“…Notably, of those who undertook iFOBT screening, the incidence of CRC was highest in those who had their subsequent iFOBT between 1.5 to 3 years, as compared to those performed 5 years or more (1.46 vs 1.08 per 1000 person years). While these studies demonstrated a benefit from undergoing colonoscopy within 3 years of the index procedure when presenting with a positive FOBT, the results are difficult to interpret as quality indicators of the index colonoscopy were not reported and these are key predictors of missed lesions[ 14 - 17 ]. The colonoscopies done at such short intervals were principally to detect missed or rapidly evolving lesions to compensate for the compromised effectiveness of a potentially inadequate quality index colonoscopy.…”

Implementing precision medicine in endoscopy practice

“…However, FIT‐positive subjects are at higher risks for advanced neoplasm and incident CRC compared with FIT‐negative population even after a negative colonoscopy and FHbC is an independent predictor for such risk 119 . Another study also reported that those who received subsequent FIT after negative colonoscopy had a significantly lower risk of incident CRC compared with those who did not (adjusted HR = 0.47) 120 . As here exist the dose‐respondent relationship of FHbC and the risk of incidence CRC, subsequent FIT could be prioritized for those with higher baseline FHbC thereby making the most efficient use of screening related capacity and resources.…”

“…119 Another study also reported that those who received subsequent FIT after negative colonoscopy had a significantly lower risk of incident CRC compared with those who did not (adjusted HR = 0.47). 120 As here exist the dose-respondent relationship of FHbC and the risk of incidence CRC, subsequent FIT could be prioritized for those with higher baseline FHbC thereby making the most efficient use of screening related capacity and resources.…”