Later fol­low-up colonoscopy equals higher col­orec­tal can­cer risk

The Philippine Star - - OPINION - CHARLES C. CHANTE, MD

Pa­tients who un­dergo fol­low-up colonoscopy 10 months or more af­ter a pos­i­tive fe­cal im­muno­chem­i­cal test are at higher risk for col­orec­tal can­cer and for more ad­vanced dis­ease at di­ag­no­sis, than are those who un­dergo im­me­di­ate (within 30 days) fol­low-up colonoscopy, ac­cord­ing to a new re­port. Clin­i­cal prac­tice guide­lines rec­om­mend fol­low-up colonoscopy af­ter a pos­i­tive fe­cal im­muno­chem­i­cal test (FIT) re­sult but dif­fer about how quickly the pro­ce­dure should be done, chiefly be­cause there is lit­tle ev­i­dence on which to base any rec­om­men­da­tion re­gard­ing tim­ing, re­ported at Kaiser Per­ma­nente North­ern Cal­i­for­nia, Oak­land, and his as­so­ci­ates.

To ex­am­ine whether the length of the in­ter­val be­tween FIT test­ing and colonoscopy af­fected di­ag­no­sis, they an­a­lyzed clin­i­cal data for 70,124 adults aged 50-75 years who were mem­bers of two large health or­ga­ni­za­tions and who com­pleted FIT test­ing dur­ing a three-year pe­riod. The in­ves­ti­ga­tors com­pared out­comes among the 27,176 pa­tients who had fol­low-up colonoscopy within 30 days (the ref­er­ence group) against those of pa­tients who had fol­low-up colonoscopy af­ter two months (24,644 pa­tients), three months (8,666 pa­tients), 4-6 months (5,251 pa­tients), 7-9 months (1,335 pa­tients), 10-12 months (748 pa­tients), or more than 12 months (2,304 pa­tients).

A to­tal of 2,191 col­orec­tal can­cers were di­ag­nosed at fol­low-up colonoscopy, in­clud­ing 601 cases of ad­vanced dis­ease, the in­ves­ti­ga­tors re­ported.

There was no sig­nif­i­cant in­crease in risk for any col­orec­tal can­cer among pa­tients who had fol­lowup colonoscopy within nine months, com­pared with the ref­er­ence group. How­ever, the risks of any col­orec­tal can­cer and of ad­vanced col­orec­tal can­cer in­creased sig­nif­i­cantly at 10 months (odds ra­tios, 1.48, 1.97).

The risks con­tin­ued to rise as the in­ter­val be­tween test­ing and colonoscopy length­ened, so that, af­ter one year, the odds ra­tios were 2.25 for any col­orec­tal can­cer and 3.22 for ad­vanced-stage dis­ease. Af­ter one year, the odds ra­tios were 1.32 for ad­vanced ade­no­mas, 2.94 for stage IV col­orec­tal can­cer.

The Na­tional Can­cer In­sti­tute sup­ported the study.

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