TOPLINE:

Among individuals with a positive fecal immunochemical test (FIT) result, colonoscopy delays of more than 3 months and up to 24 months were not associated with an increased risk for colorectal cancer (CRC), advanced‑stage CRC, or advanced adenomas. However, individuals with markedly elevated fecal hemoglobin (f-Hb) levels had a substantially higher risk for CRC.

METHODOLOGY:

• Previous studies reported that colonoscopy delays beyond 3-13 months after a positive FIT were associated with an increased risk for CRC; however, these studies had significant bias. The clinically recommended timelines, typically ranging from 1-3 months, are difficult to achieve in routine practice and may not be clinically justified given that CRC develops over many years.
• Researchers conducted a nationwide retrospective cohort study in France involving 374,113 individuals with a positive FIT result between 2016 and 2019 to examine how time to follow-up colonoscopy affects CRC outcomes.
• The primary outcome was the detection rate of CRCs, and the secondary outcomes were the detection rates of advanced-stage CRCs and advanced adenomas.

TAKEAWAY:

• In total, 21,616 CRCs (5.8%), 5453 advanced-stage CRCs (1.5%), and 122,359 advanced adenomas (32.7%) were diagnosed.
• Colonoscopy delays beyond 3 months and up to 24 months after a positive FIT were not associated with an increased risk for CRC, advanced-stage CRC, or advanced adenoma compared with the reference timeframe of 2-3 months.
• Colonoscopy within 60 days of the positive FIT result was associated with a notably higher risk for CRC and advanced-stage CRC (P < .001 for both).
• Individuals with f-Hb levels ≥ 200 μg/g had eightfold higher odds of CRC, 11-fold higher odds of advanced-stage CRC, and twofold higher odds of advanced adenoma than those with f-Hb levels of 30-40 μg/g.

IN PRACTICE:

“Based on our results, we suggest that the priority in all CRC screening programs is not to focus on the time to follow-up colonoscopy but to ensure that every participant with a positive FIT result complies with colonoscopy,” the authors wrote. “[T]he organization of a fast-track approach dedicated to FIT-positive participants would be recommended to shorten the stressful period of waiting for the colonoscopy verdict.”

SOURCE:

This study, led by Adrien Grancher, Department of Hepato-Gastroenterology and Digestive Oncology, CHU Rouen in Rouen, France, was published online in Gut.

LIMITATIONS:

Due to the retrospective design, researchers could not control unidentified confounding factors and missing data. Information about the presence of high-risk symptoms at the time of colonoscopy was not available. The study used a higher FIT positivity threshold than that used in other studies.

DISCLOSURES:

The authors did not receive specific funding for this research from any public, commercial, or nonprofit organizations. Grancher reported board membership with Merck and travel reimbursement from Bayer, Roche, and Servier. The remaining authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.