Time to Colonoscopy and Risk of Colorectal Cancer in Patients With Positive Results From Fecal Immunochemical Tests

Abstract

This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e82. Learning Objective-Upon completion of this activity, successful learners will be able to utilize current evidence to manage patients with positive fecal immunochemical test results for the purpose of colorectal cancer prevention. BACKGROUND & AIMS: In patients with positive results from a fecal immunochemical test (FIT), failure to receive a timely follow-up colonoscopy may be associated with higher risks of colorectal cancer (CRC) and advanced-stage CRC. We evaluated the prevalence of any CRC and advanced-stage CRC associated with delays in follow-up colonoscopies for patients with positive results from a FIT. METHODS: We collected data from 39,346 patients (age, 50-69 years) who participated in the Taiwanese Nationwide Screening Program from 2004 through 2012 and had completed a colonoscopy more than 1 month after a positive result from a FIT. Risks of any CRC and advanced-stage CRC (stage III-IV) were evaluated using logistic regression models and results expressed as adjusted odds ratios (aORs) and corresponding 95% CIs. RESULTS: In our cohort, 2003 patients received a diagnosis of any CRC and 445 patients were found to have advanced-stage disease. Compared with colonoscopy within 1-3 months (cases per 1000 patients: 50 for any CRC and 11 for advanced-stage disease), risks were significantly higher when colonoscopy was delayed by more than 6 months for any CRC (aOR, 1.31; 95% CI, 1.04-1.64; 68 cases per 1000 patients) and advanced-stage disease (aOR, 2.09; 95% CI, 1.43-3.06; 24 cases per 1000 patients). The risks continuously increased when colonoscopy was delayed by more than 12 months for any CRC (aOR, 2.17; 95% CI, 1.44-3.26; 98 cases per 1000 patients) and advanced-stage disease (aOR, 2.84; 95% CI, 1.43-5.64; 31 cases per 1000 patients). There were no significant differences for colonoscopy follow up at 3-6 months for risk of any CRC (aOR, 0.98; 95% CI, 0.86-1.12; 49 cases per 1000 patients) or advanced-stage disease (aOR, 0.95; 95% CI, 0.72-1.25; 10 cases per 1000 patients). CONCLUSIONS: In an analysis of data from the Taiwanese Nationwide Screening Program, we found that among patients with positive results from a FIT, risks of CRC and advanced-stage disease increase with time. These findings indicate the importance of timely colonoscopy after a positive result from a FIT.

Colorectal Cancer Survival in 50- to 69-Year-Olds after Introducing the Faecal Immunochemical Test

“…On the other hand, our data indicate that the 3-year survival rate is lower in these patients than those in the screen-detected group (75.6% vs. 93.5%). These data are in line with other studies [37] including that of Corley et al [38], based on a retrospective cohort in California, which observed a higher risk of advanced CRC stages in patients in whom a colonoscopy was performed more than 6 months after a positive FIT. In relation to this, according to the simulation model of Meester et al [39], a delay in diagnosis of more than 12 months after a positive FIT reduces the benefits of screening programmes.…”

The COVID-19 pandemic and colorectal cancer prevention: God tempers the wind to the shorn lamb

“…The fact that a time to colonoscopy after FOBT up to 6 months was not associated with any increase in CRC prevalence or in CRC stage progression supports the overall safety of an extended time to colonoscopy after a positive FOBT. Despite the intrinsic limitations of the study by Zorzi et al (a retrospective design with confounding factors that hamper causality deductions, a minority of patients with long delays, and an unknown CRC stage in one-third of cases), the findings are consistent with those of a large study from the USA 7 and another from Asia 8 that have evaluated CRC outcomes associated with variations in follow-up times. According to the report by Corley et al 7 , concerns regarding an increased risk of CRC and late-stage CRC arise about 10 months after a positive FIT result.…”

Cancer Incidence Characteristic Evolution Based on the National Cancer Registry in Taiwan

“…In 2004, Taiwan launched a national colorectal cancer screening program that provided fecal immunochemistry tests (FIT) [ 41 ], and, in 2013, it began subsidizing fecal occult blood tests (FOBT). Biennial regular screenings combined with colonoscopy [ 42 ] are expected to reduce the incidence of colorectal cancer in the future [ 43 ].…”