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CRC Prevalent When FIT is Positive, Regardless of Recent Colonoscopy
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The prevalence of colorectal cancer and advanced colorectal neoplasia is not insignificant among patients with a positive fecal immunochemical test result who have undergone recent colonoscopies, according to research published in Gastrointestinal Endoscopy.
Yoon Suk Jung, MD, PhD, of the division of gastroenterology at Kangbuk Samsung Hospital in South Korea, and colleagues wrote that the United States Multi-Society Task Force on Colorectal Cancer Screening recommends colonoscopy every 10 years or an annual FIT as first tier options for CRC screening.
“It is generally accepted that a follow-up colonoscopy is not needed for 10 years after
a negative colonoscopy in individuals at an average risk for CRC,” they wrote. “Currently, there is no consensus supporting or disproving the concomitant use of annual FIT with colonoscopy. However, in clinical practice, interval FIT is often performed despite a recent colonoscopy.”
Jung and colleagues compared the prevalence of CRC and advanced colorectal neoplasia (ACRN) based on the interval since the last colonoscopy in patients with and without a positive FIT.
Of 2,228 patients in the FIT-positive group, 514 had a colonoscopy less than three years prior (group 1), 427 had a colonoscopy between three and 10 years prior (group 2) and 1,287 had a colonoscopy more than 10 years prior (group 3).
Researchers found that the prevalence of CRC in group 1 was 2.1%, 1.6% in group 2 and 7.2% in group 3, while the prevalence of ACRN was 10.9% in group 1, 12.6% in group 2 and 26% in group 3. After adjusting for confounders, investigators found that the CRC and ACRN detection rates in group 1 were lower than those in group 3, but not lower than the rates in group 2.
Regarding the FIT-negative cohort (n = 6,135), the prevalence of CRC was 0.7% in group 1, 0.4% in group 2 and 3.4% in group 3. The prevalence of ACRN was 6% in group 1, 6.1% in group 2 and 14.7% in group 3.
Jung and colleagues wrote that FIT screening could help find cancers and polyps that were missed on previous colonoscopy screenings. However, interval FIT for all patients could mean more unnecessary colonoscopies.
“Our results support the recommendations of the U.S. Multi-Society Task Force that those with positive FIT results and recent colonoscopy should be offered a repeat colonoscopy considering the superior performance characteristics of FIT compared with that of [guaiac-based fecal occult blood testing],” they wrote. – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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