Delay in Colonoscopy Following Positive Screening Test Associated With Increased Risk of Colorectal Cancer

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, according to a study published by JAMA.
Colorectal cancer is the second leading cause of cancer death in the United States. The fecal immunochemical test (FIT) is commonly used for colorectal cancer screening and positive test results need to be followed by a complete colon examination, typically with colonoscopy; however, recommendations for how quickly to complete follow-up differ and lack a strong evidence base. Douglas A. Corley, M.D., Ph.D., of Kaiser Permanente Northern California, Oakland, and colleagues conducted a study that included patients with a positive FIT result who had a follow-up colonoscopy.
Of the 70,124 patients with positive FIT results (median age, 61 years; men, 53 percent), there were 2,191 cases of any colorectal cancer and 601 cases of advanced-stage disease diagnosed. The researchers found that there was no significant increase in risk of overall colorectal cancer or advanced colorectal cancer associated with colonoscopy follow-up within 10 months compared with 8 to 30 days. There was a higher risk of stage II colorectal cancer at 7 to 9 months; of any colorectal cancer, advanced-stage disease, and stage II and IV colorectal cancer at 10 to 12 months; and of advanced adenomas, any colorectal cancer, advanced-stage disease, and stages II-IV colorectal cancer at more than 12 months.
“Further research is needed to assess whether this relationship is causal,” the authors write.