Colonoscopy later than 270 days in a fecal immunochemical test-based population screening program is associated with higher prevalence of colorectal cancer

Abstract

Background Colorectal cancer (CRC) screening programs based on fecal immunochemical testing (FIT) generate substantial pressure on colonoscopy capacity in Europe. Thus, a relevant proportion of FIT-positive patients undergo colonoscopy after the recommended 30-day interval, which may be associated with an excess CRC risk. Methods In a cohort of 50–69-year-old patients undergoing biennial rounds of FIT (OC-Hemodia latex agglutination test; cutoff 20 µg hemoglobin/g feces) between 2004 and 2017, we assessed the outcome at colonoscopy (low/high risk adenoma/CRC/advanced stage CRC) among FIT-positive patients, according to different time intervals. The association of each outcome with waiting time, and demographic and clinical factors, was analyzed through multivariable analysis. Results 123 138/154 213 FIT-positive patients (79.8 %) underwent post-FIT colonoscopy. Time to colonoscopy was ≤ 30 days, 31–180 days, and ≥ 181 days in 50 406 (40.9 %), 71 724 (58.3 %), and 1008 (0.8 %) patients, respectively. At colonoscopy, CRC, high risk adenoma, and low risk adenoma were diagnosed in 4813 (3.9 %), 30 500 (24.8 %), and 22 986 (18.7 %) patients, respectively. An increased CRC prevalence at colonoscopy was observed for a time to colonoscopy of ≥ 270 days (odds ratio [OR] 1.75, 95 % confidence interval [CI] 1.15–2.67), whereas it was stable for waiting times of < 180 days. The proportion of advanced CRC also increased after 270 days (OR 2.79, 95 %CI 1.03–7.57). No increase for low or high risk adenomas according to time to colonoscopy was observed. Conclusion In a European FIT-based screening program, post-FIT colonoscopy after 9 months was associated with an increased risk of CRC and CRC progression.

Time to Colonoscopy After Abnormal Stool-Based Screening and Risk for Colorectal Cancer Incidence and Mortality

“…Most existing data examining the relationship between exposure to colonoscopy after abnormal stool-based screening and CRC outcomes come from international settings, do not investigate the role of time to colonoscopy, or support a range of follow-up intervals. 6,8,9,11,[13][14][15][16][17][18] Data from a 2017 Korean cohort demonstrated a 1.6-fold increased risk for CRC-specific death among patients who underwent colonoscopy (at a time) compared with those who did not. In the same patient population, CRC risk and advanced-stage disease increased when colonoscopy was delayed by more than 6 months; however, the association between time to colonoscopy and death risk was not reported.…”

“…[8][9][10] Existing data examining time to colonoscopy and clinical risk come from international settings or regional US cohorts and support a wide range of follow-up intervals (6 to 24 months). 8,9,[11][12][13][14][15][16][17][18] As a result, there are no national standards or federal quality mandates to guide patients, providers, or health care systems on the clinically acceptable period of time in which a diagnostic colonoscopy should be performed after an abnormal FIT/FOBT. 7 As FIT use increases, and especially in the setting of the ongoing global coronavirus disease 2019 (COVID- 19) pandemic that has necessitated greater reliance on noninvasive CRC screening modalities, 19,20 it is critical to further define best practice for optimal time to colonoscopic followup after abnormal results.…”

Resuming endoscopy during COVID-19 pandemic: ESGE, WEO and WGO Joint Cascade Guideline for Resource Limited Settings

“…increase in the burden of gastrointestinal diseases [1][2][3][4]. The reopening of endoscopic services is crucial to resume elective procedures but must be balanced with the need to protect healthcare personnel who are already over-represented in terms of COVID 19 morbidity and mortality [5][6][7].…”

A delay in colonoscopy after positive fecal tests leads to higher incidence of colorectal cancer: A systematic review and meta‐analysis

“…It is reasonable to hypothesize that a time lag between a positive fecal test and the follow‐up colonoscopy could risk neoplastic progression. Recent studies have addressed this question on the incidence of colorectal neoplasia being affected by the time interval between a positive fecal test and the post‐test colonoscopy 8–13 . We, therefore, decided to conduct a systematic review and meta‐analysis to evaluate the effects of timing of post‐fecal test colonoscopy on the risk of progression to CRC.…”