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Showing content from https://pubmed.ncbi.nlm.nih.gov/33545140/ below:

Time to Colonoscopy After Abnormal Stool-Based Screening and Risk for Colorectal Cancer Incidence and Mortality

Affiliations

• ¹ Division of Gastroenterology, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; Moores Cancer Center and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
• ² Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, California.
• ³ Moores Cancer Center and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
• ⁴ Division of Gastroenterology, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, California. Electronic address: s1gupta@ucsd.edu.
• ⁵ Division of Gastroenterology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, California. Electronic address: fmay@mednet.ucla.edu.

• PMID: 33545140
• PMCID: PMC8096663
• DOI: 10.1053/j.gastro.2021.01.219

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Yazmin San Miguel et al. Gastroenterology. 2021 May.

• ¹ Division of Gastroenterology, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; Moores Cancer Center and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
• ² Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, California.
• ³ Moores Cancer Center and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
• ⁴ Division of Gastroenterology, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, California. Electronic address: s1gupta@ucsd.edu.
• ⁵ Division of Gastroenterology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, California. Electronic address: fmay@mednet.ucla.edu.

• PMID: 33545140
• PMCID: PMC8096663
• DOI: 10.1053/j.gastro.2021.01.219

Item in Clipboard

Background and aims: The optimal time interval for diagnostic colonoscopy completion after an abnormal stool-based colorectal cancer (CRC) screening test is uncertain. We examined the association between time to colonoscopy and CRC outcomes among individuals who underwent diagnostic colonoscopy after abnormal stool-based screening.

Methods: We performed a retrospective cohort study of veterans age 50 to 75 years with an abnormal fecal occult blood test (FOBT) or fecal immunochemical test (FIT) between 1999 and 2010. We used multivariable Cox proportional hazards to generate CRC-specific incidence and mortality hazard ratios (HRs) and 95% confidence intervals (CI) for 3-month colonoscopy intervals, with 1 to 3 months as the reference group. Association of time to colonoscopy with late-stage CRC diagnosis was also examined.

Results: Our cohort included 204,733 patients. Mean age was 61 years (SD 6.9). Compared with patients who received a colonoscopy at 1 to 3 months, there was an increased CRC risk for patients who received a colonoscopy at 13 to 15 months (HR 1.13; 95% CI 1.00-1.27), 16 to 18 months (HR 1.25; 95% CI 1.10-1.43), 19 to 21 months (HR 1.28; 95% CI: 1.11-1.48), and 22 to 24 months (HR 1.26; 95% CI 1.07-1.47). Compared with patients who received a colonoscopy at 1 to 3 months, mortality risk was higher in groups who received a colonoscopy at 19 to 21 months (HR 1.52; 95% CI 1.51-1.99) and 22 to 24 months (HR 1.39; 95% CI 1.03-1.88). Odds for late-stage CRC increased at 16 months.

Conclusions: Increased time to colonoscopy is associated with higher risk of CRC incidence, death, and late-stage CRC after abnormal FIT/FOBT. Interventions to improve CRC outcomes should emphasize diagnostic follow-up within 1 year of an abnormal FIT/FOBT result.

Keywords: Prevention; Quality; Veterans Affairs.

Published by Elsevier Inc.

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Conflict of interest statement: There are no conflicts to report for any authors.

Flowchart of inclusion and exclusion…

Flowchart of inclusion and exclusion criteria for study cohort, 1999–2015

Flowchart of inclusion and exclusion criteria for study cohort, 1999–2015

Risk for incident CRC based…

Risk for incident CRC based on time to colonoscopy among US Veterans with…

Risk for incident CRC based on time to colonoscopy among US Veterans with abnormal FIT/FOBT, 1999–2015 (n=204,733)

Risk for fatal CRC based…

Risk for fatal CRC based on time to colonoscopy among US Veterans with…

Risk for fatal CRC based on time to colonoscopy among US Veterans with abnormal FIT/FOBT, 1999–2015; (n=204,733)

Association between time to colonoscopy…

Association between time to colonoscopy and risk for late stage colorectal diagnosis among…

Association between time to colonoscopy and risk for late stage colorectal diagnosis among Veterans with an abnormal FIT/FOBT, 1999–2015 (n=204,271)

• In CRC Screening, Timing Is Almost Everything.

  Flugelman AA, Holme Ø. Flugelman AA, et al. Gastroenterology. 2021 May;160(6):1929-1930. doi: 10.1053/j.gastro.2021.02.047. Epub 2021 Feb 25. Gastroenterology. 2021. PMID: 33640435 No abstract available.

• Fecal occult blood test for colorectal cancer screening: an evidence-based analysis.

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• Faecal immunochemical test after negative colonoscopy may reduce the risk of incident colorectal cancer in a population-based screening programme.

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• Association Between Time to Colonoscopy After Positive Fecal Testing and Colorectal Cancer Outcomes: A Systematic Review.

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• A Video Decision Aid Decreases Fear of Colonoscopy After an Abnormal Fecal Immunochemical Test Result: A Pilot Study.

  Hopkins T, Bell-Brown A, Martinez-Pinto P, Henderson V, Ko LK, Isler A, Issaka RB. Hopkins T, et al. J Cancer Educ. 2025 Apr 5. doi: 10.1007/s13187-025-02623-0. Online ahead of print. J Cancer Educ. 2025. PMID: 40186724

• Doing things right and doing the right things: Colorectal cancer screening in Saudi Arabia.

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• Inappropriate Multi-Target Stool DNA Use for Colorectal Cancer Screening: Risks, Compliance, and Outcomes.

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• Operationalizing a Rideshare Intervention for Colonoscopy Completion: Barriers, Facilitators, and Process Recommendations.

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• Rates of Follow-up Colonoscopy After a Positive Stool-Based Screening Test Result for Colorectal Cancer Among Health Care Organizations in the US, 2017-2020.

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