Fecal hemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality, analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program.
Interval colorectal cancer after colonoscopy may affect effectiveness and cost-effectiveness of screening programs.
Dr Han-Mo Chiu and colleagues from Taiwan investigated whether and how fecal hemoglobin concentration of fecal immunochemical testing affected the risk prediction of interval cancer caused by inadequate colonoscopy quality in a fecal immunochemical testing-based population screening program.
From 2004 to 2009, 29,969 subjects underwent complete colonoscopy after positive fecal immunochemical testing in the Taiwanese Nationwide Colorectal Cancer Screening Program.
|The estimated incidence was 1.14 per 1000 person-years|
The interval cancer rate was traced until the end of 2012.
The incidence of interval cancer was calculated in relation to patient characteristics, endoscopy-related factors, and fecal hemoglobin concentration.
Poisson regression analysis was performed to assess the potential risk factors for colonoscopy interval cancer.
The team found that 162 interval cancer developed after an index colonoscopy, and the estimated incidence was 1.14 per 1000 person-years of observation for the entire cohort.
Increased risk of interval cancer was most remarkable in the uptake of colonoscopy in settings with adenoma detection rate lower than 15%, and then higher fecal immunochemical testing with adjustment for older age and colorectal neoplasm detected at baseline colonoscopy.
The researchers observed similar findings for subjects with negative index colonoscopy.
Dr Chiu's team concludes, "Colonoscopy interval cancer arising from FIT-based population screening programs were mainly influenced by inadequate colonoscopy quality and independently predicted by fecal hemoglobin concentration that is associated with a priori chance of advanced neoplasm."
"This finding is helpful for future modification of screening logistics based on fecal hemoglobin concentration."