The longer a patient waits to undergo colonoscopy after receiving a positive fecal immunochemical test, the higher their risk for developing colorectal cancer, according to research published in Clinical Gastroenterology and Hepatology.
Yi-Chia Lee, MD, PhD, of the department of internal medicine at National Taiwan University Hospital, and colleagues wrote that while a two-stage approach of FIT and a follow-up colonoscopy helps allocate screening resources, the time between the two stages can leave a sizeable gap for some patients.
“This two-stage approach involved a time lag between a patient’s FIT results and colonoscopic follow-up,” they wrote. “In theory, the longer the time lag, the greater number of advanced lesions because neoplastic progression is continuous over time, and the anticipated benefit of screening may be reduced.”
To explore the prevalence of any kind of CRC, as well as advanced-stage disease, Lee and colleagues analyzed data from 39,346 patients taken from the Taiwanese Nationwide Screening Program from 2004 to 2012. Each patient had completed colonoscopy more than one month after a positive FIT result. Overall, 2,003 patients received a diagnosis of any CRC and 445 received a diagnosis of advanced-stage disease.
Investigators found that patients who waited more than six months for a colonoscopy had higher risk for all kinds of CRC (adjusted OR = 1.31; 95% CI, 1.04–1.64; 68 cases per 1,000 patients) and advanced disease (aOR = 2.09; 95% CI, 1.43–3.06; 24 cases per 1,000 patients) compared with patients who wait between one and three months. That risk increased among patients who waited more than a year (all CRC; aOR = 2.17; 95% CI, 1.44–3.26; 98 cases per 1,000 patients) and advanced-stage disease (aOR = 2.84; 95% CI, 1.43–5.64; 31 cases per 1,000 patients).
Lee and colleagues wrote that their findings could be important for national screening programs where patients with a positive FIT could get stuck in line while they wait for an available screening appointment.
“Results of this nationwide study have important implications regarding how to maximize the benefit generated from a FIT-based screening program in order to reduce the enormous burden of CRC,” they wrote. – by Alex Young
Disclosures: The authors report no relevant financial disclosures.