Determinants of colonoscopy adherence after positive colorectal cancer screening: Insights from individual and municipality-level data in Flanders.

The participation in the FIT-based colorectal cancer screening programme and subsequent compliance to colonoscopy after a positive FIT test was only slightly affected during the COVID-19 pandemic in Denmark.

BackgroundIn the Dutch colorectal cancer (CRC) screening programme, individuals receive a faecal immunochemical test (FIT) to do at home. After a positive FIT result, a follow-up colonoscopy is recommended to identify CRC or advanced adenomas (AA). GPs may influence their patients’ decisions on adherence to follow-up by colonoscopy.AimTo explore GPs’ perspectives on the CRC screening programme and their potential influence on FIT-positive patients to follow up with the recommended colonoscopy.Design & settingSemi-structured interviews among GPs in Amsterdam, the Netherlands.MethodGPs were approached using purposive sampling. Analysis was performed on 11 interviews using open coding and constant comparison.ResultsAll interviewed GPs would recommend FIT-positive patients without obvious contraindications to adhere to a follow-up colonoscopy. If patients were likely to be distressed by a positive FIT result, most GPs described using reassurance strategies emphasising a low cancer probability. Most GPs stressed the probability of false-positive FIT results. Some described taking a positive screening result in CRC screening less seriously than one in breast cancer screening. Most GPs underestimated CRC and AA probabilities after a positive FIT result. When told the actual probabilities, some stated that this knowledge might change the way they would inform patients.ConclusionThese results imply that some of the interviewed GPs have too low a perception of the risk associated with a positive FIT result, which might influence their patients’ decision-making. Simply informing GPs about the actual rates of CRC and AA found in the screening programme might improve this risk perception.

A four year old girl presented with varicella gangrenosa, and haematological investigations showed a disseminated intravascular coagulation. The child subsequently developed a unilateral deep venous thrombosis. She was treated with oral steroids and intravenous heparin and made a full recovery.

ObjectiveTo explore the performance of a protocol combining fecal immunochemical test (FIT) and a high-risk factor questionnaire (HRFQ) for selecting patients requiring colonoscopy as part of a population-based colorectal cancer (CRC) screening program in China.MethodsFrom 2015 to 2016, we conducted a CRC screening program for all residents aged 45 years or older in Tianhe District, Guangzhou City, China. Participants underwent an FIT and received an HRFQ as part of primary screening. Those with positive FIT and/or HRFQ results were considered to be at high risk and were recommended to undergo colonoscopy.ResultsA total of 10 074 subjects were recruited and enrolled in the screening program. In the enrolled population, 17.5% had positive FIT results and 19.4% had positive HRFQ results. Of those recommended to undergo diagnostic colonoscopy, 773 did so. The screening method’s overall positive predictive value (PPV) was 4.9% for non-adenomatous polyps, 11.4% for low-risk adenomas (LRAs), 15.9% for high-risk adenomas (HRAs) and 1.6% for CRC. The PPVs of positive FIT results for non-adenomatous polyps, LRAs, HRAs and CRC were 5.2%, 15.9%, 22.5% and 2.5%, respectively. The PPVs of positive HRFQ results for non-adenomatous polyps, LRA, HRA and CRC were 4.1%, 10.2%, 14.3% and 1.4%, respectively. The PPVs associated with combined positive FIT and HRFQ results for non-adenomatous polyps, LRAs, HRAs and CRC were 4.5%, 16.4%, 23.7% and 2.8%, respectively.ConclusionOur results suggest that this two-step CRC screening strategy, involving a combination of FIT and HRFQ followed by colonoscopy, is useful to identify early-stage CRC. The high detection rates and PPVs for CRC and adenomas encourage this strategy’s use in ongoing screening programs.

In more than half of the colorectal cancer screening participants with a positive fecal immunochemical test (FIT) result, no advanced neoplasia (AN) is detected at colonoscopy. The positive FIT result could also be generated by cancers located proximal to the colon: upper gastrointestinal, oral cavity, nose, and throat cancers. We evaluated screenees' risk of being diagnosed with a cancer proximal to the colon within the 3 years and compared risks between those with a positive vs those with a negative FIT. Data of Dutch colorectal cancer screening participants who underwent biennial FIT-based screening 2014-2018 were collected from the national screening database and linked to the National Cancer Registry. Screenees were classified into 3 groups: FIT-positives with AN (FIT+/AN+), FIT-positives without AN (FIT+/AN-), and FIT-negatives (FIT-). We compared the cumulative incidence of cancers proximal to the colon in each group 3 years after FIT. A Cox regression analysis with left truncation and right censoring, using FIT positivity as time-dependent variable and stratified for sex, was performed to compare the hazard of cancers proximal to the colon in participants who were FIT-positive vs FIT-negative. Three-year cumulative incidence of cancers proximal to the colon in FIT+/AN+ (n= 65,767), FIT+/AN- (n= 50,661), and FIT- (n= 1,831,647) screenees was 0.7%, 0.6%, and 0.4%, respectively (P < .001). FIT-positives were older and more frequently male than FIT-negatives (P < .001). Significantly more cancers proximal to the colon were detected among FIT-positives (P < .001; hazard ratio, 1.55; 95% CI, 1.44-1.67). FIT-positive screenees were at significantly increased risk of being diagnosed witha cancer proximal to the colon within 3 years after FIT,although the 3-year cumulative incidence was still less than 1%.

Background:Early colorectal cancer (CRC) detection helps reduce the mortality rate. This study aimed to investigate colon lesions in individuals with positive and negative fecal immunochemical test (FIT) results among the (PERSIAN) Guilan cohort study (PGCS) population.Methods:This cross-sectional study was conducted on 1158 participants over 50 who were volunteers for the FIT stool test at the Endoscopy Department of Razi Hospital, Rasht, Iran, from 2021 to 2022. The FIT test was screened for all participants, and for 172 individuals (86 individuals from each group with positive and negative FIT results), a colonoscopy was performed to investigate the colon lesions. Demographic/clinical characteristics, FIT results, colonoscopy findings, and the Bristol Stool Chart were completed. All data were analyzed using SPSS Version 16, considering a significant level<0.05.Results:Out of 1,158 participants, 86 had positive FIT results, and 172 (52.3%) were females. The colonoscopy results showed that 34.3% of the patients had colon lesions. Individuals with positive FIT exhibited a significantly higher prevalence of colon lesions (p<0.001). No statistically significant differences were observed between positive and negative FIT results, demographic and clinical characteristics, and the location of lesions in individuals with colon lesions (p>0.05). Moreover, there was a significant difference in pathological findings and the presence of adenomatous polyps regarding the FIT results (p<0.001).Conclusion:The effectiveness of FIT in the initial stages of screening for early lesion detection is considerable, especially for individuals with upper age.

Background:There is convincing evidence from epidemiological studies that meat consumption increases colorectal cancer (CRC) risk. However, assessment of any association with a positive fecal immunochemical test (FIT) in CRC screening has been limited. If a link could be shown this might be helpful for establishing a risk group for colonoscopy.Objective:This study aimed to assess any association between meat consumption and other lifestyle factors and a positive FIT result in a Thai population.Methods:A cross-sectional analytical study was conducted with 1,167 participants in a population-based randomized controlled trial. CRC was screened from May 2016 - February 2017. Subjects aged 45-74 years who met the eligibility criteria were randomly allocated to the study arm. A positive FIT was determined with cut-off 100 ng/mL. Multiple logistic regression was used to analyze any relationship between lifestyle factors and a positive FIT.Result:The total number of subjects was 1,060 (90.8% return rate of FIT). With FIT100, FIT150, and FIT200, positive tests were found in 92 (8.68%), 74 (6.98%), and 60 (5.66%), respectively. No significant associations were noted with any of the variables, except for being aged 60-74 years (ORadj = 1.62, 95%CI: 1.03-2.54) Borderline significance was observed for high consumption of vegetables (ORadj = 0.62, 95%CI: 0.36-1.07) and being male (ORadj = 1.39, 95%CI:0.87-2.22).Conclusion:Despite the evidence from the literature, no association was here found between a positive FIT result and meat consumption or other well-established lifestyle parameters. Being aged 60-74 years was a risk factor which should be taken into account in CRC screening strategy in countries like Thailand with limited access to endoscopy.

Background: The current guideline does not recommend upper gastrointestinal evaluation for patients with a positive fecal immunochemical test (FIT) and negative colonoscopy results. However, this indication was based on low-quality evidence as data on this issue are very limited. We assessed the risk of proximal cancers (oral or throat, esophageal, stomach, and small intestine cancers) after negative or positive FIT results in the Korean National Cancer Screening Program (NCSP). Methods: Using the NCSP databases, we collected data on participants who underwent FIT between 2009 and 2011. Participants were classified based on FIT results and colorectal cancer (CRC) diagnosed within 1 year after FIT as FIT− (n = 5,551,755), FIT+/CRC− (n = 368,553), and FIT+/CRC+ (n = 12,236). Results: The incidence rates of overall proximal cancers in FIT−, FIT+/CRC−, and FIT+/CRC+ patients within 1, 2, and 3 years after FIT were 0.38%, 0.68%, and 2.26%; 0.57%, 0.93%, and 2.74%; and 0.79%, 1.21%, and 3.15%, respectively. After adjusting confounding variables, the risks of esophageal, stomach, and small intestine cancers as well as overall proximal cancers within 1, 2, and 3 years after FIT were higher in FIT+/CRC− patients than those in FIT− patients. However, the risk of oral or throat cancer did not differ between FIT− and FIT+/CRC− patients. The risks for oral or throat cancer and small intestine cancer were higher in FIT+/CRC+ patients than those in FIT+/CRC− patients. Conclusions: In this population-based study, FIT+/CRC− patients were at higher risk for esophageal, stomach, and small intestine cancers than were FIT− patients, suggesting that positive FIT results were associated with these cancers.

Depending on the colorectal cancer (CRC) screening programme, a colonoscopy should be performed within 1-3 months after a positive faecal immunochemical test (FIT) result. However, such short timescales may be difficult to meet and seem trivial when most CRCs take years to develop. To assess the impact of time to colonoscopy on CRC outcomes. This French nationwide retrospective cohort study included individuals with a positive FIT result between 2016 and 2019 and a subsequent colonoscopy performed within 24 months. The risks of CRC, advanced-stage CRC and advanced adenoma (AA) according to time interval to colonoscopy were assessed and evaluated on individual and socio-geographic characteristics. Overall, 374 113 FIT-positive individuals underwent post-FIT colonoscopy (86.6% compliance rate), with 21 616 CRCs and 122 359 AAs diagnosed. Compared with the 2-3 months interval class, no increased risk of CRC, advanced-stage CRC or AA was observed after 3 months up to 24 months, with adjusted odds ratio after 12 months at 0.93 (0.95 CI 0.83 to 1.03), 1.04 (0.85 to 1.25) and 0.88 (0.82 to 0.93), respectively. Individuals with high faecal haemoglobin concentrations (f-Hb ≥200 µg/g) were respectively eight, eleven and two times more likely to have a CRC, an advanced-stage CRC or an AA as compared with the 30-40 µg/g class. No increased risk of CRC, advanced-stage CRC or AA was observed up to 24 months. Our findings suggest that ensuring colonoscopy compliance after a positive FIT may take precedence over rigid adherence to interval. The higher the f-Hb, the sooner the colonoscopy should be performed.

Is this the end of colonoscopy screening for colorectal cancer? An Asia-Pacific perspective.

BackgroundThe fecal immunochemical test (FIT) is a diagnostic modality for colorectal cancer (CRC) screening, with the US Multisociety Task Force setting an 80% adherence benchmark for follow-up colonoscopy (FUC). Guidelines recommend that FITs be performed only in the context of CRC screening.MethodsOur study is a retrospective review of all patients with positive FIT records from 2018 to 2023. Patient characteristics, FIT ordering practices, and clinical settings were collected. The compliance rates with FUC, colonoscopy diagnostic yield, and adenoma detection were analyzed, and adherent and nonadherent patients were compared via univariate and logistic regression analyses.ResultsA total of 1424 patients had positive FIT results, with ages ranging between 18 and 92 years. Among the 1424 patients, 245 (17.2%) were < 45 years (group 1), 829 (52.9%) were 45–75 years (group 2), and 350 (24.6%) were > 75 years (group 3). In group 2, 241 (16.9%) tests were conducted for CRC screening. Seven hundred and three (49.3%) positive FIT tests, including tests for abdominal pain and anemia, were carried out for diagnostic purposes. Only 618 (43.3%) patients with positive FIT results underwent FUC, of whom 277 (44.8%) had adenomas and 28 (4.5%) were diagnosed with CRC. Bivariate analysis revealed that age, fewer comorbidities, prior colonoscopy, family history of CRC, diagnostic FIT, and outpatient setting increased FUC adherence. Multivariate analysis revealed that age and outpatient setting were predictive factors.ConclusionAlthough FITs are used for CRC screening, our study found a discrepancy between guidelines and real-world practice. Compliance with FUC after a positive FIT is below the optimal range, with adherence decreasing with age.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12876-025-04455-0.

A Quarter of Participants With Advanced Neoplasia Have Discordant Results From 2-Sample Fecal Immunochemical Tests for Colorectal Cancer Screening

Mo1177 Participation, FIT-Result and Yield in Three Rounds of Biannual FIT-Based Screening in the Netherlands

Worldwide, most colorectal cancer screening programmes were paused at the start of the COVID-19 pandemic, while the Danish faecal immunochemical test (FIT)-based programme continued without pausing. We examined colorectal cancer screening participation and compliance with subsequent colonoscopy in Denmark throughout the pandemic. We used data from the Danish Colorectal Cancer Screening Database among individuals aged 50-74 years old invited to participate in colorectal cancer screening from 2018 to 2021 combined with population-wide registries. Using a generalised linear model, we estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) of colorectal cancer screening participation within 90 days since invitation and compliance with colonoscopy within 60 days since a positive FIT test during the pandemic in comparison with the previous years adjusting for age, month and year of invitation. Altogether, 3,133,947 invitations were sent out to 1,928,725 individuals and there were 94,373 positive FIT tests (in 92,848 individuals) during the study period. Before the pandemic, 60.7% participated in screening within 90 days. A minor reduction in participation was observed at the start of the pandemic (PR = 0.95; 95% CI: 0.94-0.96 in pre-lockdown and PR = 0.85; 95% CI: 0.85-0.86 in first lockdown) corresponding to a participation rate of 54.9% during pre-lockdown and 53.0% during first lockdown. This was followed by a 5-10% increased participation in screening corresponding to a participation rate of up to 64.9%. The largest increase in participation was observed among 55-59 years old and among immigrants. The compliance with colonoscopy within 60 days was 89.9% before the pandemic. A slight reduction was observed during first lockdown (PR = 0.96; 95% CI: 0.93-0.98), where after it resumed to normal levels. Participation in the Danish FIT-based colorectal cancer screening programme and subsequent compliance to colonoscopy after a positive FIT result was only slightly affected by the COVID-19 pandemic. The study was funded by the Danish Cancer Society Scientific Committee (Grant number R321-A17417) and the Danish regions.

Background:Worldwide, most colorectal cancer screening programmes were paused at the start of the COVID-19 pandemic, while the Danish faecal immunochemical test (FIT)-based programme continued without pausing. We examined colorectal cancer screening participation and compliance with subsequent colonoscopy in Denmark throughout the pandemic.Methods:We used data from the Danish Colorectal Cancer Screening Database among individuals aged 50–74 years old invited to participate in colorectal cancer screening from 2018 to 2021 combined with population-wide registries. Using a generalised linear model, we estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) of colorectal cancer screening participation within 90 days since invitation and compliance with colonoscopy within 60 days since a positive FIT test during the pandemic in comparison with the previous years adjusting for age, month and year of invitation.Results:Altogether, 3,133,947 invitations were sent out to 1,928,725 individuals and there were 94,373 positive FIT tests (in 92,848 individuals) during the study period. Before the pandemic, 60.7% participated in screening within 90 days. A minor reduction in participation was observed at the start of the pandemic (PR = 0.95; 95% CI: 0.94–0.96 in pre-lockdown and PR = 0.85; 95% CI: 0.85–0.86 in first lockdown) corresponding to a participation rate of 54.9% during pre-lockdown and 53.0% during first lockdown. This was followed by a 5–10% increased participation in screening corresponding to a participation rate of up to 64.9%. The largest increase in participation was observed among 55–59 years old and among immigrants. The compliance with colonoscopy within 60 days was 89.9% before the pandemic. A slight reduction was observed during first lockdown (PR = 0.96; 95% CI: 0.93–0.98), where after it resumed to normal levels.Conclusions:Participation in the Danish FIT-based colorectal cancer screening programme and subsequent compliance to colonoscopy after a positive FIT result was only slightly affected by the COVID-19 pandemic.Funding:The study was funded by the Danish Cancer Society Scientific Committee (Grant number R321-A17417) and the Danish regions.