EP.TU.660The rate of interval colorectal cancer within 5 years of a negative colonoscopy at a district general hospital

Abstract Aims Interval colorectal cancer is defined as cancer that has developed within a short interval of a diagnostic test that did not detect a cancer. Many authors define this interval as five years, though more complex definitions of interval cancer have been proposed. Our aim was to determine what percentage of colorectal cancers diagnosed at our hospital had a negative colonoscopy within the 5 years prior to their diagnosis. Methods We obtained details of all colorectal cancers diagnosed between 2017-2019 at our department. We then surveyed the endoscopy system to detect the patients who had a negative colonoscopy within the 5 years prior to their diagnosis, to calculate what percentage of cancers diagnosed within that period were interval cancers. Results Between 2017-2019, 539 patients were diagnosed with colorectal cancer. Age at diagnosis varied widely from 21 to 107, and 310 (57.5%) of patients were male. Seventeen patients had a negative colonoscopy within 5 years (though two of these were planned repeat procedures within a few months of the index ‘negative’ colonoscopy). We can therefore calculate the rate of interval cancer at 3.1% between 2017-2019. Conclusions The aetiology of interval colorectal cancer has been attributed to patient/tumour factors (right colon and female sex) and technical factors (adenoma detection and caecal intubation rate). Though the rate of interval cancer at our department seems pleasingly low compared to the literature, we plan to investigate the risk factors that might be at play: are biological factors to blame or can our endoscopy service be improved?

Download Full-text

Withdrawal Times, Adenoma Detection Rates, and Risk of Interval Colorectal Cancer: ACG Colorectal Cancer Prevention Award

The American Journal of Gastroenterology ◽

10.14309/00000434-201410002-02084 ◽

2014 ◽

Vol 109 ◽

pp. S613

Author(s):

Aasma Shaukat ◽

Thomas Rector ◽

Timothy Church ◽

Frank Lederle ◽

Adam Kim ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Prevention ◽

Detection Rates ◽

Adenoma Detection ◽

Adenoma Detection Rates ◽

Interval Colorectal Cancer ◽

Colorectal Cancer Prevention

Download Full-text

Association between improved adenoma detection rates and interval colorectal cancer rates after a quality improvement program

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.02.016 ◽

2020 ◽

Vol 92 (2) ◽

pp. 355-364.e5 ◽

Cited By ~ 4

Author(s):

Angela Y. Lam ◽

Yan Li ◽

Dyanna L. Gregory ◽

Joanne Prinz ◽

Jacqueline O’Reilly ◽

...

Keyword(s):

Colorectal Cancer ◽

Quality Improvement ◽

Quality Improvement Program ◽

Improvement Program ◽

Detection Rates ◽

Adenoma Detection ◽

Adenoma Detection Rates ◽

Interval Colorectal Cancer ◽

Cancer Rates

Download Full-text

Classifying interval cancers as false negatives or newly occurring in fecal immunochemical testing

Journal of Medical Screening ◽

10.1177/0969141320986830 ◽

2021 ◽

pp. 096914132098683

Author(s):

Wen-Feng Hsu ◽

Chen-Yang Hsu ◽

Amy Ming-Fang Yen ◽

Sam Li-Sheng Chen ◽

Sherry Yueh-Hsia Chiu ◽

...

Keyword(s):

Colorectal Cancer ◽

Incidence Rate ◽

Screening Program ◽

False Negative ◽

Interval Cancer ◽

Fecal Immunochemical Test ◽

Colorectal Cancers ◽

Interval Cancers ◽

False Negatives ◽

Immunochemical Test

Objective To classify interval colorectal cancers as false negatives or newly occurring cases in a biennial Fecal immunochemical test (FIT) screening program and by various interscreening intervals. Setting Data from the Taiwanese biennial colorectal cancer screening program involving FIT from 2004 to 2014 were used to estimate the incidence rate of asymptomatic colorectal cancer and the rate of its subsequent progression to clinical mode. Methods The sensitivity of detecting asymptomatic colorectal cancers excluding newly developed colorectal cancers was compared to the conventional estimate of sensitivity, the complementary FIT interval cancer rate as a percentage of the expected incidence rate ((1-I/E)%). The relative contribution of newly developed or false-negative cases to FIT interval colorectal cancers was estimated by age and interscreening intervals. Results The Taiwanese biennial fecal immunochemical test screening program had a conventional sensitivity estimate of 70.2%. After newly developed colorectal cancers were separated from FIT interval cancers, the ability to detect asymptomatic colorectal cancers increased to 75.5%. FIT interval colorectal cancers from the biennial program mainly resulted from newly developed colorectal cancers (68.8%). The corresponding figures decreased to 61.1% for the annual program but increased to 74.7% for the triennial program. The preponderance of newly developed colorectal cancers among FIT interval cancers was more prominent in screenees aged 50–59 than in those aged 60–69. Conclusions Newly developed colorectal cancers showed a predominance among the FIT interval colorectal cancers in particular in the younger population screened. It is desirable to identify high-risk individuals to offer them a short interscreening interval or advanced detection methods to reduce their odds of developing interval cancer.

Download Full-text

Postcolonoscopy colorectal cancers in average-risk Korean subjects with a normal initial colonoscopy.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.526 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 526-526

Author(s):

Han Hee Lee ◽

Hyun Ho Choi ◽

Chun-Hyun Lim ◽

Hyung-Keun Kim ◽

Sung Soo Kim ◽

...

Keyword(s):

Colorectal Cancer ◽

Advanced Adenoma ◽

Colorectal Cancers ◽

Average Risk ◽

Asian Countries ◽

Technical Improvement ◽

Advanced Neoplasia ◽

Adenoma Detection ◽

Advanced Adenomas

526 Background: There are relatively few studies regarding the incidence of postcolonoscopy colorectal cancer (PCCRC) in Asian countries. We evaluated the characteristics of PCCRC in average-risk Korean subjects. Methods: This study included subjects who were ≥ 50 years of age and had undergone a first completed colonoscopy between January 2001 and December 2004, at which no baseline adenoma had been detected, followed by a second colonoscopy 1–5 years later. The incidence and characteristics of advanced neoplasia in these subjects were assessed. Results: A total of 343 subjects underwent follow-up colonoscopy within 5 years. Seventy-three (21.3%) subjects were found to have at least one adenoma upon follow-up colonoscopy. Advanced adenoma was found in eight (2.3%) subjects, and non-advanced adenomas were found in 65 (19.0%). Five patients (1.5%) were diagnosed with invasive CRC following a normal colonoscopy. The putative reason for the PCCRCs was missed lesions in two (40.0%) and new cancer in three (60.0%) cases. Conclusions: The risk of advanced neoplasia (including PCCRCs) within 5 years after a normal baseline colonoscopy in our cohort was not low. Considering that 40% of PCCRCs were attributable to missed lesions, our results emphasize the need for technical improvement of colonoscopic examinations to improve adenoma detection.

Download Full-text

A single-centre analysis of post-colonoscopy colorectal cancer

Acta Gastro Enterologica Belgica ◽

10.51821/84.3.003 ◽

2021 ◽

Vol 84 (3) ◽

Author(s):

R Aerts ◽

C Severi ◽

G Van Roey ◽

R Harlet ◽

M T’Syen ◽

...

Keyword(s):

Colorectal Cancer ◽

Screening Colonoscopy ◽

Colorectal Cancers ◽

Average Period ◽

Right Colon ◽

Single Centre ◽

The World ◽

Important Quality ◽

The Mean ◽

The Right

Patients and methods : A prospective registration of patients with colorectal cancer and a colonoscopy within the last 10 years. We tried to classify these post-colonoscopy colorectal cancers (PCCRCs) by most reasonable explanation and into subcategories suggested by the World Endoscopy Organization (WEO) and calculated the unadjusted PCCRC rate. Results : 47 PCCRCs were identified. The average age at diagnosis of PCCRC was 73 years. PCCRCs were more located in the right colon with a higher percentage of MSI-positive and B-RAF mutated tumours. The average period between index colonoscopy and diagnosis of PCCRC was 4.2 years. Sixty-eight % of all PCCRCs could be explained by procedural factors. The mean PCCRC-3y of our department was 2.46%. Conclusions : The data of our centre are in line with the data of the literature from which can be concluded that most post-colonoscopy colorectal cancers are preventable. The PCCRC-3y is an important quality measure for screening colonoscopy. Ideally all centres involved in the population screening should measure the PCCRC-3 y annually, with cooperation of the cancer registry and reimbursement data provided by the Intermutualistic Agency (IMA).

Download Full-text

Interval colorectal cancer despite screening colonoscopy: A single-center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.401 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 401-401

Author(s):

Gudrun Resch ◽

Christian Mallinger ◽

Walter Schauer ◽

Josef Thaler ◽

Peter Knoflach

Keyword(s):

Colorectal Cancer ◽

Screening Method ◽

Interval Cancer ◽

Colorectal Adenomas ◽

Screening Colonoscopy ◽

Newly Diagnosed ◽

Technical Problems ◽

Single Center Experience ◽

Interval Colorectal Cancer ◽

Inadequate Bowel Preparation

401 Background: Colonoscopy is recommended as the primary screening method for colorectal cancer (CRC) and polypectomy is considered effective for preventing cancer. CRCs which occur within 5 years of screening colonoscopy are defined as interval cancer. Despite regular colonoscopy and complete polypectomy interval colorectal cancer may occur. Methods: All patients undergoing a colonoscopy were recorded in a colonoscopy registry, all CRC-patients who underwent colectomy were recorded in a surgery registry and all patients with newly diagnosed CRC were recorded in a tumor registry at the Klinikum Wels-Grieskirchen. In this retrospective analysis all patients with newly diagnosed CRC since the year 2000 were evaluated if a screening colonoscopy was done before the diagnosis of CRC at our institution. Results: Overall, 1.102 patients with CRC were evaluated. 939 patients underwent tumorectomy/colectomy at our department of surgery. In 65.8% (n=725) CRC was detected by colonoscopy at our institution and 85 out of these patients had a previous screening colonoscopy (range 14-176 months, median 55 months) at our institution. Interval cancers, which occur within 5 years since screening colonoscopy, were detected in 45 patients. Six patients could be identified with complete negative colonoscopy, 2 patients had inadequate bowel preparation, in 7 patients colonoscopy was not complete because of technical problems, 26 patients had a history of colorectal adenomas and 4 patients had inflammatory bowel disease. In 16 out of 26 patients with adenomas a CRC was detected distant from the side of the previous polypectomy. Conclusions: More emphasis and short-term control of incomplete and inadequately prepared colonoscopies, as well as a re-call system for post-polypectomy controls could reduce the number of so called interval CRSs.

Download Full-text

A shadow cast on a successful CRC screening programme, features of Interval Cancer FIT

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1346 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

I Idigoras Rubio ◽

I Bilbao Iturribarria ◽

M Solís Ibinagagoitia ◽

M Diaz Seoane ◽

M J Fernandez Landa ◽

...

Keyword(s):

Colorectal Cancer ◽

Cumulative Incidence ◽

Screening Programme ◽

Interval Cancer ◽

Participation Rate ◽

Cancer Registries ◽

Right Colon ◽

False Negatives ◽

Crc Screening ◽

Incidence And Mortality

Abstract Background Colorectal Cancer (CRC) Screening started in 2009 inviting biennially to carry out an immunochemical quantitative occult blood test (FIT). Overall coverage was reached in 2014 The aims of this study were to determine the main features of Interval Colorectal Cancer (CRC), related to FIT (IC_FIT= false negatives of the FIT) on the population-based screening Programme (BCSP) Methods All invitees from 2009-2016 were included in the study and with a follow-up by the Screening Coordination Centre according to the European Guidelines. Specific software was developed for the BCSP and able to be linked to medical records and cancer registries. Variables included: age at invitation, sex, type of participant (initial, regular, and irregular), TNM stage, and location (C-18.0-C-20.0), FIT threshold. Sensitivity Specificity and LR ratios were performed throughout all the period for FIT test. SPSS 23.0 Results 1,386,538 valid invitations were registered between 2009 and 2016. With a high participation rate (69.3%) and a total of 926,379 FIT negatives (94.1%). 444 CI_FIT were found before the next invitation to FIT. Most in men 60.7% (n = 278), higher on the oldest age group (60-69 years of age). 33.4% where found on regular participants on the screening. 82.1% of IC_FIT in previous rounds the FIT threshold was <10µHb/ g. Most of the IC_FIT 54.1% found on advanced Stage of the tumor, and located on the right colon (44.4%), but ringing a bell the 30.4% located on Rectum. The cumulative incidence for IC-FIT was 3.52 (IC95% 3.21-3.87) x 10,000 negative cases. Sensitivity for FIT was lower in women than men (87.7; CI 95% 85.8-89.4 vs 88.9%; CI95% 87.6-90.1) but not significant. Cumulative incidence for IC-FIT is significantly higher in men than women Conclusions The BSCP in the Basque Country shows a low incidence of Interval Cancer due to FIT. However, right colon and rectum location must be taken into account in further studies, in order to decrease the IC_FIT Key messages Participation on a BSCP is essential to decrease Incidence and mortality despite the IC_FIT (false negatives of the test). Most of the persons (82.1%) of IC_FIT group in the previous round of participation, the FIT threshold was very low.

Download Full-text

Future Prospects of Colorectal Cancer Screening: Characterizing Interval Cancers

Cancers ◽

10.3390/cancers13061328 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1328

Author(s):

Gemma Ibáñez-Sanz ◽

Rebeca Sanz-Pamplona ◽

Montse Garcia ◽

on behalf of the MSIC-SC Research Group

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Clinical Characteristics ◽

Molecular Data ◽

Screening Tests ◽

Colorectal Cancers ◽

Future Prospects ◽

Interval Cancers ◽

Molecular Features ◽

Interval Colorectal Cancer

Tumors that are not detected by screening tests are known as interval cancers and are diagnosed clinically after a negative result in the screening episode but before the next screening invitation. Clinical characteristics associated with interval colorectal cancers have been studied, but few molecular data are available that describe interval colorectal cancers. A better understanding of the clinical and biological characteristics associated with interval colorectal cancer may provide new insights into how to prevent this disease more effectively. This review aimed to summarize the current literature concerning interval colorectal cancer and its epidemiological, clinical, and molecular features.

Download Full-text