Association Between Time to Colonoscopy After a Positive Fecal Test Result and Risk of Colorectal Cancer and Cancer Stage at Diagnosis

The fecal immunochemical test (FIT) is commonly used for colorectal cancer screening and positive test results require follow-up colonoscopy. However, follow-up intervals vary, which may result in neoplastic progression. To evaluate time to colonoscopy after a positive FIT result and its association...

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Veröffentlicht in:JAMA : the journal of the American Medical Association Jg. 317; H. 16; S. 1631
Hauptverfasser: Corley, Douglas A, Jensen, Christopher D, Quinn, Virginia P, Doubeni, Chyke A, Zauber, Ann G, Lee, Jeffrey K, Schottinger, Joanne E, Marks, Amy R, Zhao, Wei K, Ghai, Nirupa R, Lee, Alexander T, Contreras, Richard, Quesenberry, Charles P, Fireman, Bruce H, Levin, Theodore R
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 25.04.2017
Schlagworte:
Aged
Cohort Studies
Colonoscopy
Colorectal Neoplasms - diagnosis
Colorectal Neoplasms - pathology
Disease Progression
Early Detection of Cancer
Female
Humans
Male
Middle Aged
Neoplasm Staging
Occult Blood
Odds Ratio
Retrospective Studies
Risk Factors
Time Factors
ISSN:1538-3598, 1538-3598
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Zusammenfassung:The fecal immunochemical test (FIT) is commonly used for colorectal cancer screening and positive test results require follow-up colonoscopy. However, follow-up intervals vary, which may result in neoplastic progression. To evaluate time to colonoscopy after a positive FIT result and its association with risk of colorectal cancer and advanced-stage disease at diagnosis. Retrospective cohort study (January 1, 2010-December 31, 2014) within Kaiser Permanente Northern and Southern California. Participants were 70 124 patients aged 50 through 70 years eligible for colorectal cancer screening with a positive FIT result who had a follow-up colonoscopy. Time (days) to colonoscopy after a positive FIT result. Risk of any colorectal cancer and advanced-stage disease (defined as stage III and IV cancer). Odds ratios (ORs) and 95% CIs were adjusted for patient demographics and baseline risk factors. Of the 70 124 patients with positive FIT results (median age, 61 years [IQR, 55-67 years]; men, 52.7%), there were 2191 cases of any colorectal cancer and 601 cases of advanced-stage disease diagnosed. Compared with colonoscopy follow-up within 8 to 30 days (n = 27 176), there were no significant differences between follow-up at 2 months (n = 24 644), 3 months (n = 8666), 4 to 6 months (n = 5251), or 7 to 9 months (n = 1335) for risk of any colorectal cancer (cases per 1000 patients: 8-30 days, 30; 2 months, 28; 3 months, 31; 4-6 months, 31; and 7-9 months, 43) or advanced-stage disease (cases per 1000 patients: 8-30 days, 8; 2 months, 7; 3 months, 7; 4-6 months, 9; and 7-9 months, 13). Risks were significantly higher for examinations at 10 to 12 months (n = 748) for any colorectal cancer (OR, 1.48 [95% CI, 1.05-2.08]; 49 cases per 1000 patients) and advanced-stage disease (OR, 1.97 [95% CI, 1.14-3.42]; 19 cases per 1000 patients) and more than 12 months (n = 747) for any colorectal cancer (OR, 2.25 [95% CI, 1.89-2.68]; 76 cases per 1000 patients) and advanced-stage disease (OR, 3.22 [95% CI, 2.44-4.25]; 31 cases per 1000 patients). Among patients with a positive fecal immunochemical test result, compared with follow-up colonoscopy at 8 to 30 days, follow-up after 10 months was associated with a higher risk of colorectal cancer and more advanced-stage disease at the time of diagnosis. Further research is needed to assess whether this relationship is causal.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1538-3598
1538-3598
DOI:10.1001/jama.2017.3634