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Patients who test positive on a fecal immunochemical test (FIT), even after a recent colonoscopy, should be offered a repeat colonoscopy. That is the conclusion following a review of 2,228 subjects who were FIT positive, which revealed a greater risk of colorectal cancer (CRC) and advanced colo-rectal neoplasia (ACRN) the longer the gap since the last colonoscopy. The findings support the recommendations of the U.S. Multi-Society Task Force on CRC Screening to offer repeat colonoscopies to FIT-positive patients, even if they recently underwent a colonoscopy.
That recommendation was based on low-quality supporting evidence, and there is currently little agreement about whether annual FIT should be performed along with colonoscopy.
The researchers set out to detect the frequency of CRC and ACRN among patients with a positive FIT test. They analyzed data from the National Cancer Screening Program in Korea, which offers an annual FIT for adults aged 50 years and older as an initial screening, followed by a colonoscopy in case of a positive result.
The researchers analyzed data from 52,376 individuals who underwent FIT at a single center in Korea during January 2013–July 2017. They excluded patients with a history of CRC or colorectal surgery, inflammatory bowel disease, or poor bowel preparation.
FIT-positive and FIT-negative patients were divided into three groups based on the length of time since their last colonoscopy: less than 3 years, 3-10 years, or more than 10 years or no colonoscopy.
Compared with FIT-negative subjects, FIT-positive individuals were more likely to be diagnosed with any colorectal neoplasia (61.3% vs. 51.8%; P less than .001), ACRN (20.0% vs. 10.3%; P less than .001), and CRC (5.0% vs. 1.9%; P less than .001).
A total of 6% of subjects had a positive FIT result, and data from 2,228 were analyzed after exclusions. They were compared with 6,135 participants who had negative FIT results but underwent a colonoscopy.
Of patients with a positive FIT result, 23.1% had a colonoscopy less than 3 years before, 19.2% had one 3-10 years prior, and 57.8% had a colonoscopy more than 10 years earlier or had never had one.
The more-than-10-year group had a higher frequency of colorectal neoplasia, ACRN, or CRC (26.0%) than did the 3 to 10-year group (12.6%), and the less-than-3-year group (10.9%; P less than .001 for all). A similar trend was seen for CRC: 7.2%, 1.6%, and 2.1%, respectively (P less than .001).
Of the 6,135 FIT-negative participants, 22.2% were in the less-than-3-years group, 28.9%, 3-10 years; and 48.8%, more-than-10 years-or-never group. The more-than-10-years group had a higher frequency of ACRN (14.7%) than did the 3 to 10-year group (0.4%) and the 0 to 3-year group (0.7%, P less than .001).
Among FIT-positive patients, the more-than-10-year group was at higher risk of ACRN diagnosis during follow-up colonoscopy than was the less-than-3-year group (adjusted OR, 3.63; 95% confidence interval, 2.48-5.31), but not compared with the 3-10-year group (aOR, 1.17; 95% CI, 0.71-1.93). The more-than-10-year group also was at greater risk of a CRC diagnosis than was the less-than-3-year group (aOR, 3.66; 95% CI, 1.74-7.73). There was no significant difference in CRC risk between the less-than-3-year group and the 3 to 10-year group (aOR, 0.58; 95% CI, 0.17-1.93).The authors suggest that CRC and ACRN found in patients who had a colonoscopy in the past 3 years are likely to be lesions that were missed in the previous exam, rather than new, fast-growing lesions. That suggests that FIT may help catch lesions that were missed during earlier screenings, though just 2.1% of the less-than-3-year group and 1.6% of the 3 to 10-year group were diagnosed with CRC, and 10.9% and 12.6% with ACRN, respectively.
The authors conclude that it may not be appropriate to offer interval FIT to all patients, since it can lead to unnecessary colonoscopies. They call for more research to determine which categories of patients are most likely to benefit from interval FIT.
The study received no funding. The authors reported no conflicts of interest.
March is Colorectal Cancer Awareness Month. AGA is here to help with patient education materials and a new video series. Visit http://crcawareness.gastro.org/ to access all the resources and share on your practice website and social media channels.
SOURCE: Kim NH et al. Gastrointest Endosc. 2019 Jan 23. doi: 10.1016/j.gie.2019.01.012.
Patients who test positive on a fecal immunochemical test (FIT), even after a recent colonoscopy, should be offered a repeat colonoscopy. That is the conclusion following a review of 2,228 subjects who were FIT positive, which revealed a greater risk of colorectal cancer (CRC) and advanced colo-rectal neoplasia (ACRN) the longer the gap since the last colonoscopy. The findings support the recommendations of the U.S. Multi-Society Task Force on CRC Screening to offer repeat colonoscopies to FIT-positive patients, even if they recently underwent a colonoscopy.
That recommendation was based on low-quality supporting evidence, and there is currently little agreement about whether annual FIT should be performed along with colonoscopy.
The researchers set out to detect the frequency of CRC and ACRN among patients with a positive FIT test. They analyzed data from the National Cancer Screening Program in Korea, which offers an annual FIT for adults aged 50 years and older as an initial screening, followed by a colonoscopy in case of a positive result.
The researchers analyzed data from 52,376 individuals who underwent FIT at a single center in Korea during January 2013–July 2017. They excluded patients with a history of CRC or colorectal surgery, inflammatory bowel disease, or poor bowel preparation.
FIT-positive and FIT-negative patients were divided into three groups based on the length of time since their last colonoscopy: less than 3 years, 3-10 years, or more than 10 years or no colonoscopy.
Compared with FIT-negative subjects, FIT-positive individuals were more likely to be diagnosed with any colorectal neoplasia (61.3% vs. 51.8%; P less than .001), ACRN (20.0% vs. 10.3%; P less than .001), and CRC (5.0% vs. 1.9%; P less than .001).
A total of 6% of subjects had a positive FIT result, and data from 2,228 were analyzed after exclusions. They were compared with 6,135 participants who had negative FIT results but underwent a colonoscopy.
Of patients with a positive FIT result, 23.1% had a colonoscopy less than 3 years before, 19.2% had one 3-10 years prior, and 57.8% had a colonoscopy more than 10 years earlier or had never had one.
The more-than-10-year group had a higher frequency of colorectal neoplasia, ACRN, or CRC (26.0%) than did the 3 to 10-year group (12.6%), and the less-than-3-year group (10.9%; P less than .001 for all). A similar trend was seen for CRC: 7.2%, 1.6%, and 2.1%, respectively (P less than .001).
Of the 6,135 FIT-negative participants, 22.2% were in the less-than-3-years group, 28.9%, 3-10 years; and 48.8%, more-than-10 years-or-never group. The more-than-10-years group had a higher frequency of ACRN (14.7%) than did the 3 to 10-year group (0.4%) and the 0 to 3-year group (0.7%, P less than .001).
Among FIT-positive patients, the more-than-10-year group was at higher risk of ACRN diagnosis during follow-up colonoscopy than was the less-than-3-year group (adjusted OR, 3.63; 95% confidence interval, 2.48-5.31), but not compared with the 3-10-year group (aOR, 1.17; 95% CI, 0.71-1.93). The more-than-10-year group also was at greater risk of a CRC diagnosis than was the less-than-3-year group (aOR, 3.66; 95% CI, 1.74-7.73). There was no significant difference in CRC risk between the less-than-3-year group and the 3 to 10-year group (aOR, 0.58; 95% CI, 0.17-1.93).The authors suggest that CRC and ACRN found in patients who had a colonoscopy in the past 3 years are likely to be lesions that were missed in the previous exam, rather than new, fast-growing lesions. That suggests that FIT may help catch lesions that were missed during earlier screenings, though just 2.1% of the less-than-3-year group and 1.6% of the 3 to 10-year group were diagnosed with CRC, and 10.9% and 12.6% with ACRN, respectively.
The authors conclude that it may not be appropriate to offer interval FIT to all patients, since it can lead to unnecessary colonoscopies. They call for more research to determine which categories of patients are most likely to benefit from interval FIT.
The study received no funding. The authors reported no conflicts of interest.
March is Colorectal Cancer Awareness Month. AGA is here to help with patient education materials and a new video series. Visit http://crcawareness.gastro.org/ to access all the resources and share on your practice website and social media channels.
SOURCE: Kim NH et al. Gastrointest Endosc. 2019 Jan 23. doi: 10.1016/j.gie.2019.01.012.
Patients who test positive on a fecal immunochemical test (FIT), even after a recent colonoscopy, should be offered a repeat colonoscopy. That is the conclusion following a review of 2,228 subjects who were FIT positive, which revealed a greater risk of colorectal cancer (CRC) and advanced colo-rectal neoplasia (ACRN) the longer the gap since the last colonoscopy. The findings support the recommendations of the U.S. Multi-Society Task Force on CRC Screening to offer repeat colonoscopies to FIT-positive patients, even if they recently underwent a colonoscopy.
That recommendation was based on low-quality supporting evidence, and there is currently little agreement about whether annual FIT should be performed along with colonoscopy.
The researchers set out to detect the frequency of CRC and ACRN among patients with a positive FIT test. They analyzed data from the National Cancer Screening Program in Korea, which offers an annual FIT for adults aged 50 years and older as an initial screening, followed by a colonoscopy in case of a positive result.
The researchers analyzed data from 52,376 individuals who underwent FIT at a single center in Korea during January 2013–July 2017. They excluded patients with a history of CRC or colorectal surgery, inflammatory bowel disease, or poor bowel preparation.
FIT-positive and FIT-negative patients were divided into three groups based on the length of time since their last colonoscopy: less than 3 years, 3-10 years, or more than 10 years or no colonoscopy.
Compared with FIT-negative subjects, FIT-positive individuals were more likely to be diagnosed with any colorectal neoplasia (61.3% vs. 51.8%; P less than .001), ACRN (20.0% vs. 10.3%; P less than .001), and CRC (5.0% vs. 1.9%; P less than .001).
A total of 6% of subjects had a positive FIT result, and data from 2,228 were analyzed after exclusions. They were compared with 6,135 participants who had negative FIT results but underwent a colonoscopy.
Of patients with a positive FIT result, 23.1% had a colonoscopy less than 3 years before, 19.2% had one 3-10 years prior, and 57.8% had a colonoscopy more than 10 years earlier or had never had one.
The more-than-10-year group had a higher frequency of colorectal neoplasia, ACRN, or CRC (26.0%) than did the 3 to 10-year group (12.6%), and the less-than-3-year group (10.9%; P less than .001 for all). A similar trend was seen for CRC: 7.2%, 1.6%, and 2.1%, respectively (P less than .001).
Of the 6,135 FIT-negative participants, 22.2% were in the less-than-3-years group, 28.9%, 3-10 years; and 48.8%, more-than-10 years-or-never group. The more-than-10-years group had a higher frequency of ACRN (14.7%) than did the 3 to 10-year group (0.4%) and the 0 to 3-year group (0.7%, P less than .001).
Among FIT-positive patients, the more-than-10-year group was at higher risk of ACRN diagnosis during follow-up colonoscopy than was the less-than-3-year group (adjusted OR, 3.63; 95% confidence interval, 2.48-5.31), but not compared with the 3-10-year group (aOR, 1.17; 95% CI, 0.71-1.93). The more-than-10-year group also was at greater risk of a CRC diagnosis than was the less-than-3-year group (aOR, 3.66; 95% CI, 1.74-7.73). There was no significant difference in CRC risk between the less-than-3-year group and the 3 to 10-year group (aOR, 0.58; 95% CI, 0.17-1.93).The authors suggest that CRC and ACRN found in patients who had a colonoscopy in the past 3 years are likely to be lesions that were missed in the previous exam, rather than new, fast-growing lesions. That suggests that FIT may help catch lesions that were missed during earlier screenings, though just 2.1% of the less-than-3-year group and 1.6% of the 3 to 10-year group were diagnosed with CRC, and 10.9% and 12.6% with ACRN, respectively.
The authors conclude that it may not be appropriate to offer interval FIT to all patients, since it can lead to unnecessary colonoscopies. They call for more research to determine which categories of patients are most likely to benefit from interval FIT.
The study received no funding. The authors reported no conflicts of interest.
March is Colorectal Cancer Awareness Month. AGA is here to help with patient education materials and a new video series. Visit http://crcawareness.gastro.org/ to access all the resources and share on your practice website and social media channels.
SOURCE: Kim NH et al. Gastrointest Endosc. 2019 Jan 23. doi: 10.1016/j.gie.2019.01.012.