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

Educational Objective
To learn whether time to colonoscopy after a positive fecal immunochemical test result is associated with the risk of colorectal cancer.
1 Credit CME
Key Points

Question  Is time to colonoscopy after a positive fecal immunochemical test (FIT) result associated with an increased risk of colorectal cancer?

Findings  In this cohort study of 70 124 patients with positive FIT results, there was no significant increase in risk of colorectal cancer or advanced-stage disease associated with colonoscopy follow-up within 10 months compared with 8 to 30 days. Follow-up after 10 months was associated with a higher risk of colorectal cancer and advanced-stage disease.

Meaning  Follow-up colonoscopy more than 10 months after a positive FIT result was associated with greater risk of colorectal cancer and more advanced disease at time of diagnosis, but further research is needed to assess whether this relationship is causal.

Abstract

Importance  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.

Objective  To evaluate time to colonoscopy after a positive FIT result and its association with risk of colorectal cancer and advanced-stage disease at diagnosis.

Design, Setting, and Participants  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.

Exposures  Time (days) to colonoscopy after a positive FIT result.

Main Outcomes and Measures  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.

Results  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).

Conclusions and Relevance  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.

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Article Information

Corresponding Author: Douglas A. Corley, MD, PhD, Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 (douglas.corley@kp.org).

Author Contributions: Dr Corley had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Corley, Jensen, Doubeni, Zauber, J.K. Lee, A.T. Lee.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Corley, Jensen, Marks.

Critical revision of the manuscript for important intellectual content: Corley, Jensen, Quinn, Doubeni, Zauber, J.K. Lee, Schottinger, Zhao, Ghai, A.T. Lee, Contreras, Quesenberry, Fireman, Levin.

Statistical analysis: Jensen, J.K. Lee, Marks, Zhao, Quesenberry, Fireman.

Obtained funding: Corley, Jensen, Quinn, Doubeni, Zauber, A.T. Lee, Levin.

Administrative, technical, or material support: Quinn, Schottinger, Marks, Ghai, A.T. Lee.

Supervision: Corley, Quinn, A.T. Lee, Levin.

Other: Contreras.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Corley reports receiving grant support from Wyeth/Pfizer. No other disclosures were reported.

Funding/Support: This study was conducted within the National Cancer Institute–funded (grant U54 CA163262) Population-based Research Optimizing Screening Through Personalized Regimens consortium, which conducts multisite, coordinated, transdisciplinary research to evaluate and improve cancer-screening processes, and by grant K07 CA212057 from the National Cancer Institute (Dr J.K. Lee).

Role of the Funder/Sponsor: The National Cancer Institute had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit for publication.

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