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Published on: June 8, 2020
Interval Positive Fecal Immunochemical Test Is Associated With Postcolonoscopy Colorectal Cancer in a Screening
Jennifer J Telford1, Edwin Khoo2, Anel Mynzhassarova2
1Cancer Prevention, Screening, and Hereditary Cancer Program, BC Cancer, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Background & Aims:
Optimal management of individuals who have an unplanned, positive fecal immunochemical test after colonoscopy before they are due for either surveillance colonoscopy or fecal immunochemical test rescreening is unknown. The aim of this study is to determine the risk of postcolonoscopy colorectal cancer in interval fecal immunochemical test-positive patients in the British Columbia Colon Screening Program.
Methods:
Population-based, retrospective cohort study of patients who underwent colonoscopy in the British Columbia Colon Screening Program between November 15, 2013, and December 31, 2021. Exclusion criteria included incomplete colonoscopy and personal history of colorectal cancer or inflammatory bowel disease. The cumulative colorectal cancer incidence was compared between 3 groups: no interval fecal immunochemical test, interval fecal immunochemical test-negative, and interval fecal immunochemical test-positive. Adjusted conditional hazard ratios for postcolonoscopy colorectal cancer were estimated using a multivariable Cox proportional hazard model with shared frailty. The model adjusted for patient sociodemographic factors and colonoscopy history.
Results:
A total of 25,438 (15.04%) of 169,117 included patients had an interval fecal immunochemical test; 21,437 (84.27%) were fecal immunochemical test-negative and 4001 (15.73%) were fecal immunochemical test-positive. Median follow-up was 43.17 months (interquartile range, 28.83-64.27 months). Cumulative incidence of postcolonoscopy colorectal cancer, adjusted for competing risk of death and follow-up time, was 0.47% (95% confidence interval, 0.37%-0.59%) in the no-interval fecal immunochemical test group, 0.17% (95% confidence interval, 0.10%-0.30%) in the interval fecal immunochemical test-negative group, and 3.02% (95% confidence interval, 1.75%-4.84%) in the interval fecal immunochemical test-positive group. Adjusted hazard ratios were 0.53 (95% confidence interval, 0.32-0.87) and 6.17 (95% confidence interval, 4.48-8.50) in the negative and positive fecal immunochemical test groups, respectively, compared with no interval fecal immunochemical test.
Conclusions:
Patients with a positive interval fecal immunochemical test are at increased risk of postcolonoscopy colorectal cancer and should be offered repeat colonoscopy.
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