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Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality: analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program
  1. Sherry Yueh-Hsia Chiu1,
  2. Shu-Ling Chuang2,
  3. Sam Li-Sheng Chen3,
  4. Amy Ming-Fang Yen3,
  5. Jean Ching-Yuan Fann4,
  6. Dun-Cheng Chang5,
  7. Yi-Chia Lee6,
  8. Ming-Shiang Wu6,
  9. Chu-Kuang Chou7,
  10. Wen-Feng Hsu6,
  11. Shu-Ti Chiou5,8,
  12. Han-Mo Chiu6
  1. 1Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan
  2. 2Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
  3. 3School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
  4. 4Department of Health Industry Management, School of Healthcare Management, Kainan University, Tao-Yuan, Taiwan
  5. 5Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
  6. 6Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  7. 7Division of Gastroenterology and Hepatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
  8. 8Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
  1. Correspondence to Dr Han-Mo Chiu, Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, No.7, Chung-Shan South Road, Taipei 100, Taiwan; hanmochiu{at}


Objectives Interval colorectal cancer (CRC) after colonoscopy may affect effectiveness and cost-effectiveness of screening programmes. We aimed to investigate whether and how faecal haemoglobin concentration (FHbC) of faecal immunochemical testing (FIT) affected the risk prediction of interval cancer (IC) caused by inadequate colonoscopy quality in a FIT-based population screening programme.

Design From 2004 to 2009, 29 969 subjects underwent complete colonoscopy after positive FIT in the Taiwanese Nationwide CRC Screening Program. The IC rate was traced until the end of 2012. The incidence of IC was calculated in relation to patient characteristics, endoscopy-related factors (such adenoma detection rate (ADR)) and FHbC. Poisson regression analysis was performed to assess the potential risk factors for colonoscopy IC.

Results One hundred and sixty-two ICs developed after an index colonoscopy and the estimated incidence was 1.14 per 1000 person-years of observation for the entire cohort. Increased risk of IC was most remarkable in the uptake of colonoscopy in settings with ADR lower than 15% (adjusted relative risk (aRR)=3.09, 95% CI 1.55 to 6.18) and then higher FHbC (μg Hb/g faeces) (100–149: aRR=2.55, 95% CI 1.52 to 4.29, ≥150: aRR=2.74, 95% CI 1.84 to 4.09) with adjustment for older age and colorectal neoplasm detected at baseline colonoscopy. Similar findings were observed for subjects with negative index colonoscopy.

Conclusions Colonoscopy ICs arising from FIT-based population screening programmes were mainly influenced by inadequate colonoscopy quality and independently predicted by FHbC that is associated with a priori chance of advanced neoplasm. This finding is helpful for future modification of screening logistics based on FHbC.


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  • The preliminary results of this study were presented during the Research Forum, Digestive Disease Week 2014 (May 6, 2014, Chicago, Illinois, USA; Abstract # 1896191).

  • Contributors Conception and design of the study: SY-HC, H-MC, Y-CL, S-LC, SL-SC, AM-FY, JC-YF; generation, collection, assembly, analysis and/or interpretation of data: H-MC, S-LC, SL-SC, AM-FY, SY-HC, D-CC and JC-YF; drafting or revision of the manuscript: SY-HC and H-MC; critical revision of the manuscript for important intellectual content; approval of the final version of the manuscript: all authors; administrative, technical or material support: S-LC, SL-SC, H-MC, AM-FY, SY-HC, JC-YF, D-CC, Y-CL, M-SW, C-KC, W-FH and S-TC; study supervision: H-MC; H-MC had the final responsibility for the decision to submit for publication.

  • Funding This study was supported by the Health Promotion Administration, Ministry of Health and Welfare (A1011119 and A1021227), and Ministry of Science and Technology (MOST 102-2314-B-182-028-MY3). The funding source had no role in study design, data collection, analysis, or interpretation, report writing, or the decision to submit this paper for publication.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Health Promotion Administration of the Ministry of Health and Welfare prior to data retrieval and analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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