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

https://doi.org/10.1016/j.cgh.2018.10.041Get rights and content
Under a Creative Commons license
open access

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.

Keywords

Prevention
Population
Colon Cancer
Endoscopy

Abbreviations used in this paper

CI
confidence interval
CRC
colorectal cancer
FIT
fecal immunochemical test
Hb
hemoglobin
OR
odds ratio

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Conflicts of interest The authors disclose no conflicts.

Funding Supported by the Health Promotion Administration, Ministry of Health and Welfare (A1011119, A1021227, A1031135, A1041122, A1051013, and A1061224). This work was also supported by the Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center), College of Public Health, National Taiwan University from the Ministry of Science and Technology (107-3017-F-002-003) and Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education in Taiwan (NTU-107L9003), and the National Taiwan University Hospital (107-T11). The funding sources had no role in study design, data collection, analysis, or interpretation, report writing, or the decision to submit this paper for publication.

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.