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Study Supports CDC Recommendation to Suspend Annual FOBT After Negative Colonoscopy
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The prevalence of adenomas or cancer was found to be low among asymptomatic patients with average risk for colorectal cancer who had a negative colonoscopy within the last 5 years, which indicates annual fecal occult blood testing can be safely suspended for up to 5 years after a negative colonoscopy.
“Through expert consensus the [CDC] recommends suspending fecal occult blood testing (FOBT) for 5 to 10 years after a negative colonoscopy in order to reduce unnecessary repeat endoscopies,” Fritz François, MD, MSc, FACG, chief of medicine, Tisch Hospital, and associate professor of medicine, NYU Langone Medical Center, told Healio Gastroenterology. “Furthermore, there is little data to guide the approach to someone with a positive FOBT after a negative colonoscopy.”
Fritz François
François and colleagues sought to ascertain the percentage of asymptomatic average-risk patients with a positive FOBT in whom advanced neoplastic lesions were detected during colonoscopy, stratified by time since their last negative colonoscopy. They prospectively identified 1,119 patients aged 50 years or older (mean age, 68.9 ± 9.6 years; 95.2% men; 48.1% white; 32.1% black; 15.6% Hispanic or Latino) who were referred for colonoscopy to evaluate a positive FOBT between June 1997 and January 2005. Demographics were similar between groups who never had a colonoscopy (n = 434), and whose last negative colonoscopy was more than 10 years ago (n = 281), 5 to 10 years ago (n = 221) or less than 5 years ago (n = 183).
Adenomas were detected in 42.8% of all patients, adenomas at least 10 mm in size were detected in 14.7%, advanced neoplasms were detected in 20.7% and cancers were detected in 7.3%. Advanced neoplastic lesions were detected in 30.4% of patients who never had a colonoscopy, in 27% of those whose last negative colonoscopy was more than 10 years ago, in 10% of those whose last negative colonoscopy was 5 to 10 years ago, and in 1.1% of those whose last negative colonoscopy was less than 5 years ago (P < .001).
“Based on a large prospective study we now report that among individuals with a positive FOBT within 5 years of a negative colonoscopy the prevalence of advanced neoplasms is only 1%,” François said. “The findings therefore support the recommendation that it is safe to suspend annual FOBT in asymptomatic average-risk patients for up to 5 years.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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