Delayed colonoscopy linked with higher risk for CRC
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Delayed colonoscopy after an abnormal stool-based screening test was associated with increased risk for colorectal cancer, according to study results.
Samir Gupta, MD, from the Veterans’ Affairs San Diego Healthcare System, one of the co-authors of the study, said in a press release that patients and even some primary care providers do not understand how important that follow-up colonoscopy can be.
“Some patients and providers even explain these results incorrectly, attributing abnormal results to hemorrhoids, something that was eaten, or other problems,” he said in the release. “The results of this study should raise awareness that delaying colonoscopy after an abnormal stool test can have major consequences, including increased risk for cancer diagnosis, late-stage cancer at diagnosis, and death from colorectal cancer.”
Gupta and colleagues conducted a retrospective cohort study of veterans aged 50 to 75 years who received an abnormal fecal occult blood test or fecal immunochemical test between 1999 and 2010 (n = 204,733). They explored CRC-specific incidence and mortality of 3-month colonoscopy intervals compared with 1 to 3 months as a reference group.
Compared with patients who underwent colonoscopy at 1 to 3 months, there was an increased risk for CRC among patients who underwent colonoscopy at 13 to 15 months (HR = 1.13; 95% CI, 1-1.27), 16 to 18 months (HR = 1.25; 95% CI, 1.1-1.43), 19 to 21 months (HR = 1.28; 95% CI, 1.11-1.48) and 22 to 24 months (HR = 1.26; 95% CI, 1.07-1.47).
Mortality was also higher among patients who underwent colonoscopy 19 to 21 months (HR = 1.52; 95% CI, 1.51-1.99) and 22 to 44 months (HR = 1.39; 95% CI, 1.03-1.88) after an abnormal stool test compared with patients who underwent colonoscopy at 1 to 3 months.
Gupta said their findings could become even more important as more stool-based screening tests are introduced into the market.
“With stool tests, such as FIT and FIT-DNA, already covered by most insurance companies and with promising new blood-based screening tests for colorectal cancer under study in large trials, the challenge of ensuring complete screening, including initial completion and follow through to colonoscopy after an abnormal test, is likely to grow substantially,” he said in the release.
Perspective
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Noma Dakhil, MD
This study supports our current practice and recommendations for patients with abnormal stool-based screening tests, including FIT, FIT-DNA and fecal occult blood. These patients require a timely colonoscopy, within 3 months of their results, to evaluate for colon polyps or even colon cancer. Colonoscopy should not be deferred to minimize the potential for progression of preclinical lesions to more advanced and less curable lesions.
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