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Screening participants with inflammatory bowel disease or high colorectal cancer risk in Denmark: a cohort study
Signe Bülow Therkildsen1, Pernille Thordal Larsen1,2, Sisse Helle Njor3,4,5
1Department of Public Health Programmes, University Research Clinic for Cancer Screening, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NØ, Denmark.
Insights
Individuals with inflammatory bowel disease (IBD) and high-risk groups experience a higher rate of false-positive results in colorectal cancer (CRC) screening using the faecal immunochemical test (FIT). This leads to unnecessary colonoscopies, suggesting a need to update screening protocols.
Area of Science:
- Gastroenterology
- Public Health
- Cancer Screening
Background:
- Current colorectal cancer (CRC) screening guidelines advise individuals with inflammatory bowel disease (IBD) and high-risk individuals against participation.
- Despite recommendations, a significant number of these individuals participate in the Danish faecal immunochemical test (FIT) screening.
- These groups exhibit a higher positive FIT rate compared to the average-risk population.
Purpose of the Study:
- To estimate the risk of false-positive screening results among individuals with IBD and high-risk individuals.
- To provide evidence for improving recommendations regarding screening participation for these populations.
- To analyze the implications of current screening practices on resource utilization.
Main Methods:
- Retrospective analysis of 71,871 FIT-positive participants from 2014-2017 who underwent colonoscopy within 3 months.
- Screening outcomes were determined using national registers within 180 days post-FIT.
- Comparison of false-positive rates between IBD/high-risk individuals and the average-risk population.
Main Results:
- A total of 26,591 participants were identified as having a false-positive screening result.
- Individuals with IBD or high CRC risk demonstrated a significantly higher risk of false-positive FIT results compared to average-risk individuals.
- The study highlights a substantial number of screening-related colonoscopies performed on individuals with IBD or high CRC risk due to false positives.
Conclusions:
- Individuals with IBD and high CRC risk have an elevated risk of false-positive screening results from FIT.
- The current screening protocols may lead to an over-performance of colonoscopies in these specific populations.
- Updated screening protocols are necessary to optimize resource allocation and patient management in CRC screening programs.
Abstract:
Individuals with inflammatory bowel disease (IBC) and high-risk individuals are advised to discuss participation with their doctor and not to participate in colorectal cancer (CRC) screening. Yet a substantial proportion still participate in the Danish faecal immunochemical test (FIT) screening and have a higher positive FIT rate than the average-risk population. We estimated the risk of false-positive screening among individuals with inflammatory bowel disease and high-risk individuals to improve recommendations regarding screening participation. We included 71,871 FIT-positive participants (2014-2017) who had a subsequent colonoscopy within 3 months. Screening outcome within 180 days was established by using registers. We determined that 26,591 of the included participants had a false-positive screening. Participants with IBC or high CRC risk had a significantly higher risk of getting a false-positive screening than the average risk population, resulting in too many screening-related colonoscopies being performed among these individuals, indicating a need to update the screening protocols.
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