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Updated: Sep 13, 2025
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Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
Published on: June 8, 2020
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Interval Colorectal Cancers in a Fecal Immunochemical Test-Based Screening Program
Wen-Feng Hsu1, Uri Ladabaum2, Chiu-Wen Su1
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
JAMA Network Open
|July 28, 2025
Summary
Interval colorectal cancer (CRC) is more common after colonoscopy than after a negative fecal immunochemical test (FIT). Higher adenoma detection rates (ADR) during colonoscopy correlate with worse survival, indicating potential limitations in current screening methods.
Area of Science:
- Gastroenterology
- Oncology
- Public Health
Background:
- Interval colorectal cancers (CRCs) are diagnosed after negative screening tests or negative colonoscopies.
- Understanding the risks associated with different screening pathways is crucial for optimizing CRC prevention strategies.
Purpose of the Study:
- To compare the incidence, mortality, and survival of interval CRC following fecal immunochemical testing (post-FIT interval CRC) versus colonoscopy (postcolonoscopy interval CRC) within Taiwan's screening program.
Main Methods:
- A cohort study analyzed participants aged 50-74 in Taiwan's CRC Screening Program (2004-2012).
- Two cohorts were defined: negative FIT results and positive FIT results with negative colonoscopy.
- Data linkage with Taiwan Cancer Registry and Death Registry (up to 2019) was used to identify interval CRC and survival outcomes.
- Analysis stratified by hospital-level adenoma detection rate (ADR).
Main Results:
- Interval CRC incidence and mortality were significantly higher after colonoscopy compared to after a negative FIT.
- Postcolonoscopy interval CRC incidence was 0.75/1000 person-years vs. 0.09/1000 person-years for post-FIT.
- Higher hospital-level ADR was associated with lower incidence and mortality of postcolonoscopy interval CRC, but paradoxically, higher CRC-specific death within this subgroup.
- Adjusted hazard ratios indicated a 7-fold higher incidence and 5-fold higher mortality for postcolonoscopy vs. post-FIT interval CRC.
Conclusions:
- Individuals with positive FIT results undergoing colonoscopy have a substantially higher risk of developing CRC.
- Higher ADR during colonoscopy may indicate more thorough examination but is linked to worse survival for interval CRC, suggesting limitations in current colonoscopic surveillance.
- Further research is needed to explore the interplay between procedural factors and biological aspects influencing CRC outcomes.
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