118 CHRONOLOGICAL TREND OF COLONOSCOPY KEY QUALITY INDICATORS AND INCIDENCE OF POST-COLONOSCOPY COLORECTAL CANCER IN FECAL IMMUNOCHEMICAL TEST-BASED SCREENING PROGRAM IN TAIWAN

Background Symptomatic invitees are advised not to participate in colorectal cancer (CRC) screening but to directly consult their general practitioner (GP), because fecal immunochemical test (FIT) sensitivity for cancer is not optimal. This recommendation may not always be followed in daily practice. We evaluated how many FIT-positive participants had CRC-related symptoms and whether the presence of symptoms was associated with the presence and location of CRC/advanced neoplasia. Methods We prospectively collected data on CRC-related symptoms in all FIT-positive participants in the Dutch CRC screening program, referred to our endoscopy centers between 2014 and 2016, and evaluated whether symptoms were associated with detected CRC/advanced neoplasia at colonoscopy. Results Of 527 FIT-positive participants, 314 had advanced neoplasia, of which 41 had CRC. Overall, 246 (47%; 95% confidence interval (CI) 0.42–0.51) reported CRC-related symptoms. A change in bowel habits (odds ratio (OR) 2.86, CI 1.23–6.62) and visible blood in stool (OR 8.65, CI 2.34–32.0) were associated with the detection of CRC at colonoscopy. We did not observe significant associations between evaluated symptoms and advanced neoplasia. Conclusions A large proportion of FIT-positive screening participants have CRC-related symptoms. This suggests that current instructions do not retain symptomatic screening invitees from participation and awareness of CRC-related symptoms is inadequate.

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Colorectal cancer after negative colonoscopy in fecal immunochemical test-positive participants from a colorectal cancer screening program

Endoscopy International Open ◽

10.1055/a-0650-4296 ◽

2018 ◽

Vol 06 (09) ◽

pp. E1140-E1148 ◽

Cited By ~ 4

Author(s):

Liseth Rivero-Sánchez ◽

Jaume Grau ◽

Josep María Augé ◽

Lorena Moreno ◽

Angels Pozo ◽

...

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Fecal Immunochemical Test ◽

Colorectal Adenomas ◽

Crc Screening ◽

Cancer Screening Program ◽

Screening Strategies ◽

Immunochemical Test ◽

Low Incidence

Abstract Background and study aims Colorectal cancer (CRC) risk after a positive fecal immunochemical test (FIT) and negative colonoscopy is unknown. We aimed to ascertain the cumulative incidence of post-colonoscopy colorectal cancer (PCCRC) and the manifestation of other lesions that could explain the test positivity in individuals with a negative colonoscopy in a population screening program. Patients and method Observational study in participants from the first round of a CRC screening program (2010 – 2012) with positive-FIT (≥ 20 μg/g of feces) and negative colonoscopy (without neoplasia). A 42- to 76-month follow-up was performed searching in the National Health Service database and by a brief structured telephonic interview. Results Of 2659 FIT-positive individuals who underwent colonoscopy, 811 (30.5 %) had a negative colonoscopy. Three PCCRC (0.4 %) were detected within 11 – 28 months and accelerated carcinogenesis was ruled out. Among those with normal colonoscopy, 32 (5 %) relevant lesions were detected at follow-up. One-third of them (11/32) were significant neoplasias: a gastric cancer, a small-bowel lymphoma, six advanced colorectal adenomas, and the three PCCRC. The 21 remaining lesions were inflammatory, vascular disorders, or non-advanced colorectal adenomas. Conclusions The vast majority (95 %) of individuals did not present any subsequent lesion that could explain the FIT positivity. The very low incidence (0.4 %) and characteristics of PCCRC observed in our cohort reinforce the concept that, although a positive FIT preselects high risk individuals, a high quality colonoscopy is the paramount factor in preventing PCCRC. Improving quality standards of colonoscopy are required to strengthen the current CRC screening strategies.

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