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

Yi-Chia Lee; Jean Ching-Yuan Fann; Tsung-Hsien Chiang; Shu-Lin Chuang; Sam Li-Sheng Chen; Han-Mo Chiu; Amy Ming-Fang Yen; Sherry Yueh-Hsia Chiu; Chen-Yang Hsu; Wen-Feng Hsu; Ming-Shiang Wu; Hsiu-Hsi Chen

doi:10.1016/j.cgh.2018.10.041

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

Clin Gastroenterol Hepatol. 2019 Jun;17(7):1332-1340.e3. doi: 10.1016/j.cgh.2018.10.041. Epub 2018 Nov 1.

Authors

Affiliations

¹ Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: yichialee@ntu.edu.tw.
² Department and Graduate Institute of Health Care Management, Kainan University, Tao-Yuan, Taiwan.
³ Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁴ Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
⁵ School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
⁶ Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
⁷ Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁸ Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁹ Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.

PMID: 30391435
DOI: 10.1016/j.cgh.2018.10.041

Abstract

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: Colon Cancer; Endoscopy; Population; Prevention.

Publication types

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

MeSH terms

Aged
Biomarkers, Tumor / metabolism*
Colonoscopy / methods*
Colorectal Neoplasms / diagnosis*
Colorectal Neoplasms / epidemiology
Colorectal Neoplasms / metabolism
Feces / chemistry
Female
Follow-Up Studies
Humans
Immunohistochemistry / methods*
Incidence
Male
Mass Screening / methods*
Middle Aged
Retrospective Studies
Taiwan / epidemiology
Time Factors

Substances

Biomarkers, Tumor