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Okagawa Y, Sumiyoshi T, Hanada K, Hirokawa S, Tomita Y, Yoshida M, Minagawa T, Morita K, Yane K, Ihara H, Hirayama M, Kondo H. Is annual screening by fecal immunochemical test necessary after a recent colonoscopy? DEN OPEN 2025; 5:e385. [PMID: 38770399 PMCID: PMC11103454 DOI: 10.1002/deo2.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
Objective The population-based colorectal cancer screening guidelines in Japan recommend an annual fecal immunochemical test (FIT). However, there is no consensus on the need for annual FIT screening for patients who recently performed a total colonoscopy (TCS). Therefore, we evaluated the repeated TCS results for patients with positive FIT after a recent TCS to assess the necessity of an annual FIT. Methods We reviewed patients with positive FIT in opportunistic screening from April 2017 to March 2022. The patients were divided into two groups: those who had undergone TCS within the previous 5 years (previous TCS group) and those who had not (non-previous TCS group). We compared the detection rates of advanced neoplasia and colorectal cancer between the two groups. Results Of 671 patients, 151 had received TCS within 5 years and 520 had not. The detection rates of advanced neoplasia in the previous TCS and non-previous TCS groups were 4.6% and 12.1%, respectively (p < 0.01), and the colorectal cancer detection rates were 0.7% and 1.5%, respectively (no significant difference). The adenoma detection rates were 33.8% in the previous TCS group and 40.0% in the non-previous TCS group (no significant difference). Conclusions Only a few patients were diagnosed with advanced neoplasia among the patients with FIT positive after a recent TCS. For patients with adenomatous lesions on previous TCS, repeated TCS should be performed according to the surveillance program without an annual FIT. The need for an annual FIT for patients without adenomatous lesions on previous TCS should be prospectively assessed in the future.
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Affiliation(s)
- Yutaka Okagawa
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | | | - Kota Hanada
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | - Sota Hirokawa
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | - Yusuke Tomita
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | | | | | - Kohtaro Morita
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | - Kei Yane
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | - Hideyuki Ihara
- Department of GastroenterologyTonan HospitalHokkaidoJapan
| | | | - Hitoshi Kondo
- Department of GastroenterologyTonan HospitalHokkaidoJapan
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Larsen PT, Jørgensen SF, Rasmussen M, Andersen B, Cross AJ, Njor SH. Colorectal cancer incidence following a negative colonoscopy in fecal immunochemical test-based screening: a nationwide cohort study after 8 years of screening in Denmark. Endoscopy 2025. [PMID: 40118099 DOI: 10.1055/a-2551-1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2025]
Abstract
Screening participants with a positive fecal immunochemical test (FIT) result and a subsequent negative colonoscopy are quarantined from the Danish bowel cancer screening program for 8 years. This recommendation is based on evidence from settings other than FIT-based screening, but referral of this evidence is not necessarily sufficient. We estimated the colorectal cancer (CRC) risk among these FIT-positive/colonoscopy-negative individuals and compared it with the risk in a historical unscreened population.Using national health registers in Denmark, we compared 29 936 participants with a positive FIT but negative colonoscopy with 720 850 randomly selected unscreened controls born 9 years earlier (ratio 1:24). Controls were assigned a pseudo-colonoscopy date 9 years prior to the negative colonoscopy group. We examined cases per 10 000 person-years and estimated relative risks (RR) and 95%CIs for CRC.After 8 years' follow-up, CRC risk was lower among FIT-positive/colonoscopy-negative participants compared with controls (RR 0.72, 95%CI 0.61-0.84). By age group and sex, the lower risk was only evident for women and men in their 60s (RR 0.67 [95%CI 0.47-0.96] and RR 0.65 [95%CI 0.48-0.88], respectively) and men in their 70s (RR 0.60 [95%CI 0.44-0.84]).The overall risk for CRC was lower for individuals with a positive FIT but negative colonoscopy compared with unscreened controls. However, the lower risk might not justify 8 years of quarantine, especially for women and younger age groups. Individualized screening is warranted and transfer of evidence from non-FIT screening should be done carefully.
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Affiliation(s)
- Pernille T Larsen
- University Research Clinic for Cancer screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University Faculty of Health Sciences, Aarhus, Denmark
- Research Unit for Screening and Epidemiology, Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark
| | - Susanne F Jørgensen
- Research Unit for Screening and Epidemiology, Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Danish Colorectal Cancer Center South, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Morten Rasmussen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University Faculty of Health Sciences, Aarhus, Denmark
| | - Amanda J Cross
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Sisse H Njor
- Department of Clinical Medicine, Aarhus University Faculty of Health Sciences, Aarhus, Denmark
- Research Unit for Screening and Epidemiology, Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Danish Colorectal Cancer Center South, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
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Sekiguchi M, Westerberg M, Löwbeer C, Forsberg A. Endoscopist adenoma detection rate associated with neoplasia detection during subsequent-round colonoscopy in fecal immunochemical test-based colorectal cancer screening: cross-sectional analysis of the SCREESCO randomized controlled trial. Gastrointest Endosc 2025:S0016-5107(25)00067-7. [PMID: 39914632 DOI: 10.1016/j.gie.2025.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 12/08/2024] [Accepted: 01/26/2025] [Indexed: 03/10/2025]
Abstract
BACKGROUND AND AIMS In colorectal cancer screening with the fecal immunochemical test (FIT), the optimal follow-up after first-round colonoscopy for a positive FIT, particularly after negative colonoscopy, is unknown. Therefore, using Screening of Swedish Colons (SCREESCO) study data, we aimed to elucidate the risk factors for the detection of colorectal neoplasia in second-round colonoscopy, which can affect recommendations for the optimal follow-up. METHODS We performed a cross-sectional analysis using data from SCREESCO participants undergoing colonoscopy after a positive 2-stool FIT, with a positivity cutoff value of ≥10 μg/g feces, in both the first and second rounds separated by a 2-year interval. We assessed the associations between colorectal neoplasia detection in second-round colonoscopy and participant characteristics, FIT concentrations, first-round colonoscopy results, and endoscopists' adenoma detection rates (ADRs), which were categorized as very low, low, intermediate, and high. RESULTS This study included 343 individuals. Despite negative first-round colonoscopies (n = 230), colorectal cancer and advanced colorectal neoplasia (ACN) were detected in 0.9% and 8.3% of participants in the second-round colonoscopy, respectively. An association was demonstrated between the first-round endoscopists' ADRs and the risk of second-round ACN detection. The multivariable odds ratios of the first-round intermediate and high ADRs, compared with the very low ADR, for second-round ACN detection were 0.17 (95% confidence interval [CI], 0.02-0.79) and 0.19 (95% CI, 0.04-0.86), respectively. CONCLUSIONS The impact of endoscopists' ADRs on ACN detection in subsequent-round colonoscopies underscores the importance of considering ADR for optimal follow-up after first-round colonoscopy in an FIT-based screening program.
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Affiliation(s)
- Masau Sekiguchi
- Endoscopy Division/Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Marcus Westerberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Christian Löwbeer
- Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Chemistry, SYNLAB Sverige, Täby, Sweden
| | - Anna Forsberg
- Division of Clinical Epidemiology, Department of Medicine K2, Solna, Karolinska Institutet, Stockholm, Sweden
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Kawamura T, Oda Y, Toyoizumi H, Kato M, Sekiguchi M, Takamaru H, Mizuguchi Y, Horiguchi G, Kobayashi K, Sada M, Yokoyama A, Utsumi T, Tsuji Y, Ohki D, Takeuchi Y, Shichijo S, Ikematsu H, Matsuda K, Teramukai S, Kobayashi N, Matsuda T, Saito Y, Tanaka K. Risk of colorectal cancer among fecal immunochemical test-positive individuals by timing of previous colonoscopy: A multicenter analysis. J Gastroenterol Hepatol 2025; 40:153-158. [PMID: 39478410 DOI: 10.1111/jgh.16796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 09/03/2024] [Accepted: 10/20/2024] [Indexed: 01/28/2025]
Abstract
BACKGROUND AND AIM The risk of colorectal cancer among fecal immunochemistry test-positive individuals who had undergone previous colonoscopies remains unclear. Therefore, this study aimed to determine the differences in the risk of colorectal cancer among fecal immunochemistry test-positive individuals according to the timing of their previous colonoscopies. METHODS This multicenter, retrospective, observational study was conducted in Japan as a subgroup analysis of the J-SCOUT study (UMIN000040690), which integrated and analyzed a database comprising all colonoscopies performed at participating Japanese institutions between 2010 and 2020. This study used colonoscopy data of fecal immunochemistry test-positive individuals aged ≥ 20 years from three facilities that entered the timing of previous colonoscopies into the endoscopy database. Histologically confirmed advanced neoplasia was the study's primary outcome. Multivariate logistic regression analysis was used to calculate the odds ratios for each variable. RESULTS In total, 11,143 fecal immunochemistry test-positive patients underwent colonoscopy during the study period. Of these, 10,160 patients were included in the analysis after excluding those who met the exclusion criteria. The overall advanced neoplasia detection rate was 9.38% (953/10,160; 95% confidence interval: 8.82-9.96%). Compared with the first colonoscopy, the odds ratios for advanced neoplasia in individuals who underwent colonoscopies 1, 2, 3, 4, 5, > 5, and ≥ 10 years previously were 0.27, 0.15, 0.06, 0.10, 0.29, 0.31, and 0.31, respectively. CONCLUSIONS The detection rates of advanced neoplasia were low among the fecal immunochemistry test-positive individuals who had undergone colonoscopy, particularly in the past 5 years.
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Affiliation(s)
- Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Yasushi Oda
- Oda GI Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
| | - Hirobumi Toyoizumi
- Department of Endoscopy, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Masayuki Kato
- Department of Endoscopy, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Go Horiguchi
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Miwa Sada
- Department of Gastroenterology, Kitasato University, Kanagawa, Japan
| | - Akira Yokoyama
- Department of Therapeutic Oncology, Kyoto University, Kyoto, Japan
| | - Takahiro Utsumi
- Department of Gastroenterology and Hepatology, Kyoto University, Kyoto, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Daisuke Ohki
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Koji Matsuda
- Department of Gastroenterology, Shizuoka Medical Center, Shizuoka, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nozomu Kobayashi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
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Hotta K, Matsuda T, Sano Y, Fujii T, Saito Y. Surveillance after Endoscopic Resection for Colorectal Tumors: A Comprehensive Review. Digestion 2024; 106:131-137. [PMID: 39571558 PMCID: PMC11932109 DOI: 10.1159/000542665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 11/13/2024] [Indexed: 12/24/2024]
Abstract
BACKGROUND The goal of surveillance after the endoscopic resection of colorectal tumors is to reduce colorectal cancer (CRC) incidence and mortality. Considering the effective use of the limited endoscopic capacity and the cost of surveillance, it is desirable to develop a surveillance program that is as minimal as possible. In Europe (European Society of Gastrointestinal Endoscopy [ESGE]) and the USA (Multi-Society Task Force [MSTF]), after the results of the National Polyp Study (NPS) were established, guidelines were developed that stratified risk based on initial endoscopy, and surveillance programs for each risk group were proposed. More than 10 years later, the "colonoscopy screening and surveillance guidelines" were developed with the basic principle of "aiming for zero CRC deaths during surveillance, bowel preservation, and emphasis on patient quality of life" as the guideline principles in Japan. SUMMARY Randomized controlled trials to evaluate the appropriate surveillance intervals after endoscopic resection of colorectal tumors, the NPS, the Nottingham Study, and the Japan Polyp Study (JPS), are summarized. The ESGE, USMSTF, and Japanese guidelines compared low-risk adenoma, high-risk adenoma, advanced neoplasia, piecemeal resection, and serrated lesions by category. KEY MESSAGES Surveillance guidelines based on risk stratification were developed in Japan. Guidelines are meaningful only when they are effectively utilized in clinical practice. They must also be revised based on new evidence. It is hoped that new knowledge will be accumulated, especially in Japan, on topics that are currently lacking. BACKGROUND The goal of surveillance after the endoscopic resection of colorectal tumors is to reduce colorectal cancer (CRC) incidence and mortality. Considering the effective use of the limited endoscopic capacity and the cost of surveillance, it is desirable to develop a surveillance program that is as minimal as possible. In Europe (European Society of Gastrointestinal Endoscopy [ESGE]) and the USA (Multi-Society Task Force [MSTF]), after the results of the National Polyp Study (NPS) were established, guidelines were developed that stratified risk based on initial endoscopy, and surveillance programs for each risk group were proposed. More than 10 years later, the "colonoscopy screening and surveillance guidelines" were developed with the basic principle of "aiming for zero CRC deaths during surveillance, bowel preservation, and emphasis on patient quality of life" as the guideline principles in Japan. SUMMARY Randomized controlled trials to evaluate the appropriate surveillance intervals after endoscopic resection of colorectal tumors, the NPS, the Nottingham Study, and the Japan Polyp Study (JPS), are summarized. The ESGE, USMSTF, and Japanese guidelines compared low-risk adenoma, high-risk adenoma, advanced neoplasia, piecemeal resection, and serrated lesions by category. KEY MESSAGES Surveillance guidelines based on risk stratification were developed in Japan. Guidelines are meaningful only when they are effectively utilized in clinical practice. They must also be revised based on new evidence. It is hoped that new knowledge will be accumulated, especially in Japan, on topics that are currently lacking.
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Affiliation(s)
- Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yasushi Sano
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care, Sano Hospital, Kobe, Japan
| | | | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Chiu HM, Matsuda T. Adopting Non-invasive Approaches into Precision Colorectal Cancer Screening. Dig Dis Sci 2024:10.1007/s10620-024-08696-z. [PMID: 39516436 DOI: 10.1007/s10620-024-08696-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 10/14/2024] [Indexed: 11/16/2024]
Abstract
Effective screening is essential to reducing CRC incidence and mortality by detecting the disease at early stages and identifying non-invasive precursors. While colonoscopy remains the most sensitive modality to visualize and remove neoplastic lesions thereby reducing CRC and the related death, its high cost and invasive nature limit its widespread use. The fecal immunochemical test (FIT), which offers a non-invasive alternative with higher public acceptance and comparable cost-effectiveness to colonoscopy, has become the preferred screening method in many regions. Newer non-invasive tests, such as multitarget stool DNA or RNA tests, have shown improved sensitivity for CRC and advanced adenomas, although their high costs and lower specificity present challenges for large-scale implementation. Blood-based circulating cell-free DNA test also offer promise but still require optimization to be cost-effective. The heterogeneity of the screening population further complicates the effectiveness of CRC screening programs. Variations in non-communicable disease risk factors, such as metabolic syndrome, lifestyle habits, and comorbidities, can significantly influence CRC risk and screening outcomes. Moreover, diverse screening behaviors, including inconsistent adherence to recommended screening intervals and the interchangeable use of different screening modalities, add complexity to achieving uniform effectiveness across populations. This variability underscores the need for personalized screening strategies that consider individual risk profiles and screening behaviors, as well as the application of cutting-edge technologies such as big data analytics, artificial intelligence, and digital twin approaches to evaluate its effectiveness. This article reviews the current CRC screening strategies, the advantages of non-invasive methods, and the potential of fecal hemoglobin concentration, to tailor screening intervals and improve risk stratification. It also discusses the emerging role of real-world data and advanced technologies in enhancing CRC screening accuracy and effectiveness, particularly in complex real-world scenarios where traditional methods may fall short. Before novel non-invasive approaches, such as ctDNA tests or polygenic risk scores, are validated and proven cost-effective, exploring the clinical utility of FIT and its quantitative measurement in both screening and surveillance by integrating real-world clinical big data seems a feasible direction for achieving sustained development in population screening.
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Affiliation(s)
- Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan.
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
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Qin H, Zhang M, Zhang G, Zhao L, Zhang H, Zhang W, Wang Y, Zhang X, Xie L, Qian B. Enhancing colorectal cancer screening in high-risk population through fecal immunochemical test surveillance: Results from a surveillance program. Cancer Med 2024; 13:e70145. [PMID: 39428708 PMCID: PMC11491543 DOI: 10.1002/cam4.70145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 07/05/2024] [Accepted: 08/09/2024] [Indexed: 10/22/2024] Open
Abstract
BACKGROUND Current guidelines recommend colonoscopy-based surveillance to decrease the risk of colorectal cancer (CRC) among these participants with above-average risk. The fecal immunochemical test (FIT) holds promise as a viable alternative surveillance tool, but the existing evidence regarding the use of settings remains limited. Therefore, our aim is to evaluate the CRC incidence rates in individuals with above-average CRC risk and the relationship between FIT surveillance and CRC incidence. METHODS The retrospective cohort study was performed based on the CRC screening program between January 2012 and December 2022, in Tianjin, China. This cohort study included 12,515 participants aged 40-74 years with above-average risk. The primary outcomes were the incidence rates of CRC and advanced colorectal neoplasia which were expressed as the number of events per 100,000 person-years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. RESULTS We included 12,515 participants aged 40-74 years, of whom 4980 received subsequent FIT surveillance during the study period. Among these participants, 51 CRC cases occurred in the non-FIT surveillance group (incidence rate, 233.88 per 100,000 person-years) and there were 29 cases of CRC in the FIT surveillance group (incidence rate, 184.85 per 100,000 person-years), resulting in an incidence rate ratio (IRR) of 0.58 (95% CI, 0.37-0.91). Meanwhile, 428 advanced colorectal neoplasia cases were reported in the non-FIT surveillance group, while 269 cases occurred in the FIT surveillance group, with significantly lower incidence of advanced colorectal neoplasia in the FIT surveillance group (IRR: 0.64; 95% CI, 0.55-0.74). Compared with the non-FIT surveillance group, the FIT surveillance group had a 54% decreased risk of developing CRC (HR, 0.46; 95% CI, 0.29-0.74) and a 45% decreased risk of developing advanced colorectal neoplasia (HR, 0.55; 95% CI, 0.47-0.64). CONCLUSIONS In this retrospective cohort study, above-average risk individuals who received subsequent FIT in the intervals between colonoscopies were associated with a reduction of CRC and advanced colorectal neoplasia incidence, which indicated the value and utility of FIT in the surveillance program.
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Affiliation(s)
- Hai Qin
- Department of Colorectal Surgery, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Department of Preventive and health care, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Colorectal Cancer Screening OfficeTianjin Institute of ColoproctologyTianjinChina
| | - Mingqing Zhang
- Department of Colorectal Surgery, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Colorectal Cancer Screening OfficeTianjin Institute of ColoproctologyTianjinChina
| | - Guanglu Zhang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lizhong Zhao
- Department of Colorectal Surgery, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Department of Preventive and health care, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Colorectal Cancer Screening OfficeTianjin Institute of ColoproctologyTianjinChina
| | - Huan Zhang
- Cancer Prevention CenterTianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for CancerTianjinChina
| | - Weituo Zhang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
- Clinical Research Institute, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yijia Wang
- Department of Pathology, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Laboratory of Oncologic Molecular Medicine, Tianjin Union Medical CenterNankai UniversityTianjinChina
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical CenterNankai UniversityTianjinChina
- Colorectal Cancer Screening OfficeTianjin Institute of ColoproctologyTianjinChina
| | - Li Xie
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
- Clinical Research Institute, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Clinical Research Promotion and Development CenterShanghai Hospital Development CenterShanghaiChina
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Hsiao BY, Chiang CJ, Yang YW, Lin LJ, Hsieh PC, Hsu TH, Lee WC. Insights Into Colorectal Cancer Screening: A Multidatabase Cohort Study of Over 1.5 Million Taiwanese. Am J Prev Med 2024; 67:339-349. [PMID: 38697323 DOI: 10.1016/j.amepre.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION Colorectal cancer (CRC) remains a significant public health concern. This study aims to provide a comprehensive understanding of the effectiveness of fecal immunochemical test (FIT) screening on CRC incidence and mortality, leveraging the scale of over 1.5 million randomly selected Taiwanese and more than 11.7 million person-years of follow-up. METHODS This prospective cohort study merges data from 3 robust Taiwanese health databases: the CRC screening program, cancer registration, and death registration databases. Incidence and mortality rates of CRC were calculated based on age, sex, urbanization, and past screening status. Cox proportional hazard models were used to assess the association between screening statuses and CRC incidence or mortality, adjusting for age, sex, and urbanization levels. Statistical analysis of the data was conducted in 2021-2022. RESULTS FIT screening was associated with a 33% reduction in CRC incidence and a 47% reduction in mortality. The study identified a dose-response relationship between the fecal hemoglobin concentration (f-HbC) levels and CRC risk. Participants with consistent FIT-negative results had significantly reduced CRC incidence and mortality risks, while those with one or more positive FIT results faced increased risks. Notably, compliance with follow-up examinations after a positive FIT significantly lowered mortality risk. CONCLUSIONS This large-scale study validates the efficacy of FIT screening in reducing CRC incidence and mortality. It offers a nuanced understanding of how various screening statuses impact CRC risks, thus providing valuable insights for public health strategies aimed at CRC prevention.
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Affiliation(s)
- Bo-Yu Hsiao
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan
| | - Ya-Wen Yang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan
| | - Li-Ju Lin
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Pei-Chun Hsieh
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Tsui-Hsia Hsu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan; Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Jiang L, Xu F, Feng W, Fu C, Zhou C. The value of hypersensitivity quantitative fecal immunochemical test in early colorectal cancer detection. Postgrad Med J 2024; 100:135-141. [PMID: 38055911 DOI: 10.1093/postmj/qgad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
At present, both the incidence and mortality rates of colorectal cancer are on the rise, making early screening a crucial tool in reducing the fatality rate. Although colonoscopy is the recommended method according to the guidelines, compliance tends to be poor. The fecal immunochemical test (FIT), a new technology that uses latex immunoturbidimetry to detect fecal blood, offers high specificity and sensitivity. Additionally, it is low-cost, easy to operate, and less likely to be affected by food and drugs, thus improving the compliance rate for population screening. Compared to other screening techniques, FIT represents a safer and more accurate option. This article reviews the application of FIT in early colorectal cancer screening.
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Affiliation(s)
- Lianghong Jiang
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Fen Xu
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Weiwei Feng
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Chen Fu
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Changjiang Zhou
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
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10
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van de Schootbrugge-Vandermeer HJ, Kooyker AI, Wisse PHA, Nagtegaal ID, Geuzinge HA, Toes-Zoutendijk E, de Jonge L, Breekveldt ECH, van Vuuren AJ, van Kemenade FJ, Ramakers CRB, Dekker E, Lansdorp-Vogelaar I, Spaander MCW, van Leerdam ME. Interval post-colonoscopy colorectal cancer following a negative colonoscopy in a fecal immunochemical test-based screening program. Endoscopy 2023; 55:1061-1069. [PMID: 37793423 PMCID: PMC10684335 DOI: 10.1055/a-2136-6564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND In the Dutch colorectal (CRC) screening program, fecal immunochemical test (FIT)-positive individuals are referred for colonoscopy. If no relevant findings are detected at colonoscopy, individuals are reinvited for FIT screening after 10 years. We aimed to assess CRC risk after a negative colonoscopy in FIT-positive individuals. METHODS In this cross-sectional cohort study, data were extracted from the Dutch national screening information system. Participants with a positive FIT followed by a negative colonoscopy between 2014 and 2018 were included. A negative colonoscopy was defined as a colonoscopy during which no more than one nonvillous, nonproximal adenoma < 10 mm or serrated polyp < 10 mm was found. The main outcome was interval post-colonoscopy CRC (iPCCRC) risk. iPCCRC risk was reviewed against the risk of interval CRC after a negative FIT (FIT IC) with a 2-year screening interval. RESULTS 35 052 FIT-positive participants had a negative colonoscopy and 24 iPCCRCs were diagnosed, resulting in an iPCCRC risk of 6.85 (95 %CI 4.60-10.19) per 10 000 individuals after a median follow-up of 1.4 years. After 2.5 years of follow-up, age-adjusted iPCCRC risk was approximately equal to FIT IC risk at 2 years. CONCLUSION Risk of iPCCRC within a FIT-based CRC screening program was low during the first years after colonos-copy but, after 2.5 years, was the same as the risk in FIT-negative individuals at 2 years, when they are reinvited for screening. Colonoscopy quality may therefore require further improvement and FIT screening interval may need to be reduced after negative colonoscopy.
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Affiliation(s)
| | - Arthur I. Kooyker
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Pieter H. A. Wisse
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Iris D. Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hiltje A. Geuzinge
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lucie de Jonge
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Emilie C. H. Breekveldt
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anneke J. van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Christian R. B. Ramakers
- Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Monique E. van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Pilonis N. Positive fecal immunochemical test but negative colonoscopy: what's next? Endoscopy 2023; 55:1070-1071. [PMID: 37922956 DOI: 10.1055/a-2182-6316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Nastazja Pilonis
- Department of Oncological Gastroenterology, National Research Institute of Oncology, Warsaw, Poland
- Division of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
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12
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Zhang S, Zhao S, Bai Y. New Quality Indicators for Colonoscopy: More Issues Should Be Addressed. Clin Gastroenterol Hepatol 2023; 21:3196. [PMID: 36720298 DOI: 10.1016/j.cgh.2023.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Song Zhang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shengbing Zhao
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
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13
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Hsu WF, Su CW, Hsu CY, Yen AMF, Chen SLS, Chiu SYH, Lee YC, Hsu TH, Lin LJ, Chia SL, Wu MS, Chen HH, Chiu HM. Double-contrast barium enema is no longer justified as a backup examination for colonoscopy in the population screening program: Population study in an organized fecal immunochemical test-based screening program. J Gastroenterol Hepatol 2023; 38:1299-1306. [PMID: 37078599 DOI: 10.1111/jgh.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/12/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND AND AIM Currently, some countries still acknowledge double-contrast barium enema (DCBE) as a backup confirmatory examination when colonoscopy is not feasible or incomplete in colorectal cancer (CRC) screening programs. This study aims to compare the performance of colonoscopy and DCBE in terms of the risk of incident CRC after negative results in the fecal immunochemical test (FIT)-based Taiwan Colorectal Cancer Screening Program. METHODS Subjects who had positive FITs and received confirmatory exams, either colonoscopy or DCBE, without the findings of neoplastic lesions from 2004 to 2013 in the screening program comprised the study cohort. Both the colonoscopy and DCBE subcohorts were followed until the end of 2018 and linked to the Taiwan Cancer Registry to identify incident CRC cases. Multivariate analysis was conducted to compare the risk of incident CRC in both subcohorts after controlling for potential confounders. RESULTS A total of 102 761 colonoscopies and 5885 DCBEs were performed after positive FITs without neoplastic findings during the study period. By the end of 2018, 2113 CRCs (2.7 per 1000 person-years) and 368 CRCs (7.6 per 1000 person-years) occurred in the colonoscopy and DCBE subcohorts, respectively. After adjusting for major confounders, DCBE had a significantly higher risk of incident CRC than colonoscopy, with an adjusted HR of 2.81 (95% CI = 2.51-3.14). CONCLUSIONS In the FIT screening program, using DCBE as a backup examination was associated with a nearly threefold risk of incident CRC compared with colonoscopy, demonstrating that it is no longer justified as a backup examination for incomplete colonoscopy.
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Affiliation(s)
- Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiu-Wen Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Yang Hsu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsui-Hsia Hsu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Li-Ju Lin
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shu-Li Chia
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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14
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Sung JJY, Chiu HM, Lieberman D, Kuipers EJ, Rutter MD, Macrae F, Yeoh KG, Ang TL, Chong VH, John S, Li J, Wu K, Ng SSM, Makharia GK, Abdullah M, Kobayashi N, Sekiguchi M, Byeon JS, Kim HS, Parry S, Cabral-Prodigalidad PAI, Wu DC, Khomvilai S, Lui RN, Wong S, Lin YM, Dekker E. Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance. Gut 2022; 71:2152-2166. [PMID: 36002247 DOI: 10.1136/gutjnl-2022-327377] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 12/09/2022]
Abstract
The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.
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Affiliation(s)
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Finlay Macrae
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Vui Heng Chong
- Raja Isteri Pengiran Anak Saleha Hospital, Brunei, Brunei Darussalam
| | - Sneha John
- Digestive Health, Endoscopy, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jingnan Li
- Peking Union Medical College Hospital, Beijing, China
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Simon S M Ng
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Murdani Abdullah
- Division of Gastroenterology, Pancreatibiliar and Digestive Endoscopy. Department of Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia.,Human Cancer Research Center. IMERI. Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nozomu Kobayashi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Masau Sekiguchi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Jeong-Sik Byeon
- University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Soo Kim
- Yonsei University, Seoul, Korea (the Republic of)
| | - Susan Parry
- National Bowel Screening Programme, New Zealand Ministry of Health, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | | | | | | | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny Wong
- Lee Kong Chian School of Medicine, Singapore
| | - Yu-Min Lin
- Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - E Dekker
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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15
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Rattan N, Willmann L, Aston D, George S, Bassan M, Abi-Hanna D, Anandabaskaran S, Ermerak G, Ng W, Koo JH. To scope or not - the challenges of managing patients with positive fecal occult blood test after recent colonoscopy. World J Gastrointest Oncol 2022; 14:1798-1807. [PMID: 36187395 PMCID: PMC9516652 DOI: 10.4251/wjgo.v14.i9.1798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/12/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a major health problem. There is minimal consensus of the appropriate approach to manage patients with positive immunochemical fecal occult blood test (iFOBT), following a recent colonoscopy.
AIM To determine the prevalence of advanced neoplasia in patients with a positive iFOBT after a recent colonoscopy, and clinical and endoscopic predictors for advanced neoplasia.
METHODS The study recruited iFOBT positive patients who underwent colonoscopy between July 2015 to March 2020. Data collected included demographics, clinical characteristics, previous and current colonoscopy findings. Primary outcome was the prevalence of CRC and advanced neoplasia in a patient with positive iFOBT and previous colonoscopy. Secondary outcomes included identifying any clinical and endoscopic predictors for advanced neoplasia.
RESULTS The study included 1051 patients (male 53.6%; median age 63). Forty-two (4.0%) patients were diagnosed with CRC, 513 (48.8%) with adenoma/sessile serrated lesion (A-SSL) and 257 (24.5%) with advanced A-SSL (AA-SSL). A previous colonoscopy had been performed in 319 (30.3%). In this cohort, four (1.3%) were diagnosed with CRC, 146 (45.8%) with A-SSL and 56 (17.6%) with AA-SSL. Among those who had a colonoscopy within 4 years, none had CRC and 7 had AA-SSL. Of the 732 patients with no prior colonoscopy, there were 38 CRCs (5.2%). Independent predictors for advanced neoplasia were male [odds ratio (OR) = 1.80; 95% confidence interval (CI): 1.35-2.40; P < 0.001), age (OR = 1.04; 95%CI: 1.02-1.06; P < 0.001) and no previous colonoscopy (OR = 2.07; 95%CI: 1.49-2.87; P < 0.001).
CONCLUSION A previous colonoscopy, irrespective of its result, was associated with low prevalence of advanced neoplasia, and if performed within four years of a positive iFOBT result, was protective against CRC.
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Affiliation(s)
- Nivedita Rattan
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - Laura Willmann
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
| | - Diana Aston
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
| | - Shani George
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
| | - Milan Bassan
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - David Abi-Hanna
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
| | | | - George Ermerak
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - Watson Ng
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
| | - Jenn Hian Koo
- Gastroenterology and Liver Services, Liverpool Hospital, Liverpool 2170, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2052, New South Wales, Australia
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16
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Clark GR, Fraser CG, Strachan JA, Steele RJ. 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. J Med Screen 2022; 29:249-254. [PMID: 35747907 PMCID: PMC9574424 DOI: 10.1177/09691413221110012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective How faecal haemoglobin concentrations (f-Hb) vary from one round to the next
in a colorectal cancer (CRC) screening programme, and relate to colonoscopy
findings, are unknown. Our aim was to use data from the first two rounds of
the faecal immunochemical test (FIT) based Scottish Bowel Screening
Programme (SBoSP) to explore these issues. Methods Faecal haemoglobin concentration (f-Hb) percentiles in the second round were
compared with those in the first when the first round yielded a negative FIT
result (<80 µg Hb/g faeces), a positive FIT but no colonoscopy, CRC, all
adenoma, and a negative colonoscopy. In addition, the outcomes in the first
and second rounds were compared. Results The profiles of f-Hb in the first and second rounds differed in (a) those who
had had a negative FIT result in the first round and (b) those in whom
neoplastic pathology had been found. In contrast, the pattern of difference
between profiles in those who had had a negative colonoscopy was very
similar to that in those in whom an adenoma had been found. In addition, the
risk of CRC being diagnosed in the second round after a negative colonoscopy
in the first was 3.0%, not very different to that after a negative test
result (4.9%). Conclusions Adenomas may be rarely the cause of a positive FIT result. An alternative
explanation as to why these are detected using FIT is required. In addition,
a negative colonoscopy for a positive FIT result does not rule out the
finding of significant neoplastic pathology in the next round.
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Affiliation(s)
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, UK
| | - Judith A Strachan
- Blood Sciences and Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, UK
| | - Robert Jc Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, UK
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