What Interval Between a Positive Fecal Immunochemical Test and Follow-Up Colonoscopy Is Safe?

Summary and Comment |
April 27, 2017

What Interval Between a Positive Fecal Immunochemical Test and Follow-Up Colonoscopy Is Safe?

  1. Thomas L. Schwenk, MD

No excess risk for colorectal cancer was noted until a delay of 10 months or longer.

  1. Thomas L. Schwenk, MD

How quickly after a positive fecal immunochemical test (FIT) should colonoscopy be performed? In this retrospective cohort study, researchers looked at risk for any colorectal cancer (CRC) or advanced (stage III or IV) CRC in patients with positive FIT screening who underwent follow-up colonoscopies in a large California healthcare system. Among 1.26 million screened patients, about 107,000 had positive FITs, about 70,000 underwent colonoscopy, and 2191 cancers were found. Median time to follow-up colonoscopy was 37 days.

When colonoscopy was performed during the 30 days after a positive FIT, any CRC and advanced CRC were detected in 3.0% and 0.8% of patients, respectively. These detection rates remained similar for colonoscopies performed during the next 9 months. However, rates increased to 4.9% and 1.9%, respectively, at 10 to 12 months after FIT, and increased further to 7.6% and 3.1%, respectively, beyond 12 months after FIT.

Comment

This study did not include actual clinical outcomes associated with various follow-up intervals, but outcomes can be inferred from the detected CRC stages. Adjusted analyses accounted for many patient, demographic, and clinical factors but could not account for more subtle reasons (e.g., patient anxiety or presence of symptoms) for why colonoscopy was performed sooner or later after positive FITs. In any case, it's reassuring to know that a delay of as long as 10 months — whether for logistical, financial, or personal reasons — does not confer excess CRC risk.

Editor Disclosures at Time of Publication

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

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