Delay in Colonoscopy After Positive FIT May Be Lethal, Particularly in 40- to 49-Year-Olds

Delay in Colonoscopy After Positive FIT May Be Lethal, Particularly in 40- to 49-Year-Olds

Douglas K. Rex, MD, MASGE, reviewing Zhu Y, et al. Gastroenterology 2023 Aug 18.

These data are from a population-based Chinese screening program involving 595,180 persons aged 40 to 74 years with 16 years of follow-up. There were 42,353 persons who adhered to colonoscopy after a positive fecal immunochemical test (FIT) and 32,070 who did not.

The risks of colorectal cancer (CRC) and CRC death were higher in the individuals with nonadherence (hazard ratio, [HR], 1.25 and 1.85, respectively). CRC and CRC mortality rates were higher in the distal colon in patients who did not adhere (HR, 1.36 and 1.98, respectively) but not higher in the proximal colon. CRC risk among those with nonadherence had an HR of 2.01 in 40- to 49-year-olds compared with 1.34 in 50- to 64-year-olds and 1.06 in 65- to 74-year-olds, with similar mortality trends.

Douglas K. Rex, MD, FASGE

COMMENT

This large study confirms the potential lethality of delaying colonoscopy after a positive FIT. The greater risk with distal cancers makes sense, given the higher sensitivity of FIT for distal neoplasia. The reason for increased risk in younger people is uncertain but may reflect the distal distribution of cancers in younger versus older individuals and the aggressive nature of early-onset CRC.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Zhu Y, Li X, Hu Y, Chen K, Zheng S, Ding K; Colorectal Cancer Screening Research Group. Non-adherence to referral colonoscopy after positive fecal immunochemical test increases the risk of distal colorectal cancer mortality. Gastroenterology 2023 Aug 18. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2023.08.013)

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