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Postcolonoscopy Colorectal Cancer in Fecal Immunochemical Test-Positive Individuals: Prevalence, Predictors, and Root Cause Analysis in a Nationwide Cohort

  • 0Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
The American Journal of Gastroenterology +

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July 7, 2025

|

July 7, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Postcolonoscopy colorectal cancer (PCCRC) occurred in 6.4% of individuals screened with fecal immunochemical tests (FIT). Missed lesions and incomplete polyp removal were primary causes, highlighting areas for colonoscopy quality improvement.

Area Of Science

  • Gastroenterology
  • Oncology
  • Public Health

Background

  • Postcolonoscopy colorectal cancer (PCCRC) is a critical indicator of colonoscopy quality.
  • Evaluating PCCRC predictors and rates is essential for improving CRC screening programs.

Purpose Of The Study

  • To identify predictors of PCCRC in individuals testing positive via fecal immunochemical test (FIT).
  • To determine the 3-year PCCRC (PCCRC-3y) rate.
  • To conduct a root cause analysis (RCA) of PCCRC cases.

Main Methods

  • Retrospective cohort study using the Veterans Affairs national database (January 2015-July 2022).
  • Included FIT-positive patients undergoing colonoscopy; PCCRC defined as CRC diagnosed ≥6 months post-colonoscopy.
  • Employed World Endoscopy Organization methodology for RCA and PCCRC-3y rate calculation.

Main Results

  • Identified 132 PCCRCs in 52,167 FIT-positive individuals; the PCCRC-3y rate was 6.4%.
  • Key root causes included missed lesions (41%), incomplete polyp resection (22%), and detected but unresected lesions (19.7%).
  • Independent PCCRC predictors included advanced age (70+ years) and specific adenoma characteristics (tubulovillous, high-grade dysplasia).

Conclusions

  • The PCCRC-3y rate of 6.4% in FIT-positive individuals underscores the need for enhanced colonoscopy quality.
  • Missed lesions and incomplete polyp resection are significant contributors to PCCRC.
  • Findings offer valuable insights for optimizing quality metrics within FIT-based colorectal cancer screening programs.

Keywords:

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