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. 2021 May;160(6):1997-2005.e3.
doi: 10.1053/j.gastro.2021.01.219. Epub 2021 Feb 2.

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

Yazmin San Miguel  1 , Joshua Demb  2 , Maria Elena Martinez  3 , Samir Gupta  4 , Folasade P May  5
Affiliations

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

Yazmin San Miguel et al. Gastroenterology. 2021 May.

Abstract

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.

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Conflict of interest statement

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

Figures

Figure 1:
Figure 1:
Flowchart of inclusion and exclusion criteria for study cohort, 1999–2015
Figure 2:
Figure 2:
Risk for incident CRC based on time to colonoscopy among US Veterans with abnormal FIT/FOBT, 1999–2015 (n=204,733)
Figure 3:
Figure 3:
Risk for fatal CRC based on time to colonoscopy among US Veterans with abnormal FIT/FOBT, 1999–2015; (n=204,733)
Figure 4:
Figure 4:
Association between time to colonoscopy and risk for late stage colorectal diagnosis among Veterans with an abnormal FIT/FOBT, 1999–2015 (n=204,271)
See this image and copyright information in PMC

Comment in

  • 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.

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