Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality: analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program

Sherry Yueh-Hsia Chiu; Shu-Ling Chuang; Sam Li-Sheng Chen; Amy Ming-Fang Yen; Jean Ching-Yuan Fann; Dun-Cheng Chang; Yi-Chia Lee; Ming-Shiang Wu; Chu-Kuang Chou; Wen-Feng Hsu; Shu-Ti Chiou; Han-Mo Chiu

doi:10.1136/gutjnl-2015-310256

Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality: analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program

Gut. 2017 Feb;66(2):293-300. doi: 10.1136/gutjnl-2015-310256. Epub 2015 Oct 29.

Authors

Affiliations

¹ Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan.
² Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
³ School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Department of Health Industry Management, School of Healthcare Management, Kainan University, Tao-Yuan, Taiwan.
⁵ Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan.
⁶ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁷ Division of Gastroenterology and Hepatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
⁸ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.

Abstract

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.

Keywords: COLONOSCOPY; COLORECTAL CANCER; COLORECTAL CANCER SCREENING; COLORECTAL NEOPLASIA; SCREENING.

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Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenoma / diagnosis*
Aged
Colonoscopy / standards*
Colorectal Neoplasms / diagnosis*
Early Detection of Cancer*
Feces / chemistry*
Female
Hemoglobins / analysis*
Humans
Immunochemistry
Male
Middle Aged
Occult Blood*
Predictive Value of Tests
Program Evaluation
Risk Assessment
Taiwan / epidemiology

Substances

Hemoglobins