Positive Fecal Immunochemical Test Result Research Articles

Risk of cancers proximal to the colon in fecal immunochemical test positive screenees in a colorectal cancer screening program

In more than half of the colorectal cancer (CRC) 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 three years and compared risks between those with a positive versus those with a negative FIT. Data of Dutch CRC 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 three 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 three 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 FIT-positives versus FIT-negatives. 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<0.001). FIT-positives were older and more frequently male than FIT-negatives (p<0.001). Significantly more cancers proximal to the colon were detected among FIT-positives (p<0.001; hazard ratio 1.55, 95% CI: 1.44 to 1.67). FIT-positive screenees were at significantly increased risk of being diagnosed with a cancer proximal to the colon within three years after FIT, though the three-year cumulative incidence was still less than one percent.

Performance of OC-Auto Micro 80 Fecal Immunochemical Test in an Integrated Academic-Community Health System.

We aimed to determine the performance of the OC-Auto Micro 80 fecal immunochemical test (FIT) in an average-risk population receiving care in an integrated, academic-community health system. The FIT is the most used colorectal cancer (CRC) screening test worldwide. However, many Food and Drug Administration-cleared FIT products have not been evaluated in clinical settings. We performed a retrospective cohort study of patients (50 to 75y old) in the University of Washington Medicine health care system who were screened for CRC by OC-Auto Micro 80 FIT between March 2016 and September 2021. We used electronic health records to extract patient-level and clinic-level factors, FIT use, colonoscopy, and pathology findings. The primary outcomes were the FIT positivity rate and neoplasms detected at colonoscopy. Secondary outcomes were FIT positivity by sex and safety-net versus non-safety-net clinical settings. We identified 39,984 FITs completed by 26,384 patients; 2411 (6.0%) had a positive FIT result (>100 ng/mL of hemoglobin in buffer), and 1246 (51.7%) completed a follow-up colonoscopy. The FIT positive rate was 7.0% in men and 5.2% in women (P <0.01). Among those who completed a colonoscopy after an abnormal FIT result, the positive predictive value for CRC, advanced adenoma, and advanced neoplasia was 3.0%, 20.9%, and 23.9%, respectively. In a retrospective analysis of a large heterogeneous population, the OC-Auto Micro 80 FIT for CRC screening demonstrated a positivity rate of 6.0% and a positive predictive value for CRC of 3.0%.

Nonadherence to Referral Colonoscopy After Positive Fecal Immunochemical Test Results Increases the Risk of Distal Colorectal Cancer Mortality

Nonadherence to Referral Colonoscopy After Positive Fecal Immunochemical Test Results Increases the Risk of Distal Colorectal Cancer Mortality

Can we do better? A qualitative study in the East of England investigating patient experience and acceptability of using the faecal immunochemical test in primary care

ObjectivesThe faecal immunochemical test (FIT) is increasingly used in UK primary care to triage patients presenting with symptoms and at different levels of colorectal cancer risk. Evidence is scarce on...

Antithrombotic drug use does not affect the fecal immunochemical test PPV for colorectal cancer, but warfarin may have an impact in a Japanese cohort

The fecal immunochemical test (FIT) is used for colorectal cancer (CRC) screening. Patients on antithrombotic drugs (ATs) are often screened for CRC, but the effect of ATs on FIT results is controversial. We divided individuals with FIT-positive results into two groups, patients treated with and without ATs, and retrospectively compared invasive CRC rates, advanced neoplasia detection rates (ANDRs), adenoma detection rates (ADRs), and polyp detection rates (PDRs) between the two groups. We evaluated the factors influencing the FIT positive predictive value (PPV) using propensity matching, adjusting for age, sex, and bowel preparation. We enrolled 2327 individuals (54.9% male; mean age, 66.7 ± 12.7 years). We grouped 463 individuals into the AT user group and 1864 into the nonuser group. Patients in the AT user group were significantly older and more likely to be male. After propensity score matching for age, sex, and Boston bowel preparation scale, the ADR and PDR in the AT user group were significantly lower than those in the nonuser group. Univariate logistic analysis revealed that multiple AT use (odds ratio [OR]: .39, p<0.001) had the lowest OR for FIT PPV, followed by age- and sex-adjusted factors for the ADR and any AT use (OR: .67, p=0.0007). No significant factors related to AT use were observed among age-adjusted predictive factors for invasive CRC, but warfarin use was a borderline significant positive predictive factor (OR: 2.23, p=0.059). AT use may not affect the PPV for detecting invasive CRC in patients with positive FIT results, but warfarin may have an impact.

Linked-Color Imaging Detects More Colorectal Adenoma and Serrated Lesions: An International Randomized Controlled Trial

Effects of linked-color imaging (LCI) on colorectal lesion detection and colonoscopy quality remain controversial. This study compared the detection rates of adenoma and other precursor lesions using LCI vs white-light imaging (WLI) during screening, diagnostic, and surveillance colonoscopies. This randomized controlled trial was performed at 11 institutions in 4 Asian countries/regions. Patients with abdominal symptoms, a primary screening colonoscopy, positive fecal immunochemical test results, or undergoing postpolypectomy surveillance were recruited and randomly assigned in a 1:1 ratio to either the LCI or high-definition WLI group. The primary outcome was adenoma detection rate (ADR). Secondary outcomes were polyp detection rate, advanced ADR, sessile serrated lesion (SSL) detection rate, and the mean number of adenomas per colonoscopy. The recommended surveillance schedule distribution after trial colonoscopy was analyzed. Between November 2020 and January 2022, there were 3050 participants (LCI, n= 1527; WLI, n= 1523) recruited. The LCI group ADR was significantly higher than the WLI group ADR using intention-to-treat (58.7% vs 46.7%; P < .01) and per-protocol analyses (59.6% vs 46.4%; P < .01). The LCI group polyp detection rates (68.6% vs 59.5%; P < .01), SSL detection rates (4.8% vs 2.8%; P < .01), and adenomas per colonoscopy (1.48 vs 1.02; P < .01) also were significantly higher. However, the advanced ADR was not significantly different (13.2% vs 11.0%; P= .06). Significantly more patients in the LCI group had shorter recommended surveillance schedules than the WLI group (P < .01). Compared with WLI, LCI improved adenoma and other polyp detection rates, including SSLs, resulting in alteration of the recommended surveillance schedule after screening, diagnostic, and postpolypectomy surveillance colonoscopies. UMIN000042432 (https://www.umin.ac.jp/ctr/index.htm).

Endoscopist Characteristics and Polyp Detection in Colonoscopy: Cross-Sectional Analyses of Screening of Swedish Colons

Endoscopist Characteristics and Polyp Detection in Colonoscopy: Cross-Sectional Analyses of Screening of Swedish Colons

S295 Preliminary Observations of FIT Testing for Colorectal Cancer (CRC) Prevention in Two Public Hospitals in New York City

Introduction: Expanding colorectal cancer screening (CRC) on a population level is essential in decreasing CRC mortality. Fecal immunochemical test (FIT) has an important role in improving screening rates. Currently, CRC guidelines recommend annual fecal immunochemical test (FIT) with follow up colonoscopy for all positive tests. We reviewed our experience with FIT testing for CRC screening at our institutions between July 2019 and December 2021. Methods: Eligible primary care clinic patients were given FIT kits with information on how to perform and submit the samples either during face-to-face visits or by mail. Eligible patients were identified as those aged 50-75 due for CRC screening, defined as those without a colonoscopy in the prior 10 years or FIT kit in the prior one year. Among patients who received FIT kits by mail, no standard education was provided about CRC, its screening, or the role of colonoscopy in prevention. A de-identified database was constructed containing demographic variables, process measures, colonoscopy quality measures and outcome measures in FIT+ patients. Results: One hundred seventy-six patients had positive FIT with a positivity rate of 7.2%. Mean age was 60+/-12 years and 52% were female. Follow up colonoscopies were ordered in 73% and performed in 52% of those ordered, representing only 38% of all positive FIT requiring a follow up colonoscopy. Mean and median intervals between +FIT and colonoscopy was 4 months. Of colonoscopies not performed, the patient refused in 54% while system issues were responsible in 21%. Quality metrics, including cecal intubation rates, withdrawal times, and adenoma detection rates (ADR) all met or exceeded benchmarks. The ADR was 58%, almost twice the benchmark, and the detection rate for advanced adenomas was 21%. Eight patients had cancers (11.9%) of which 6 had signs or symptoms and 4 were advanced. There were no interval cancers detected and no complications occurred. Conclusion: Among primary care clinic patients with positive FITs, we found that a low percentage completed their follow up colonoscopies. Among those who did complete colonoscopy, there were high detection rates for both adenomas and advanced adenomas. This highlights the importance of colonoscopy and demonstrates that enhanced pre-FIT educational efforts may be needed to increase adherence to colonoscopy follow up in patients with positive FIT results.

Fecal Immunochemical Testing in Patients With Low-Risk Symptoms of Colorectal Cancer: A Diagnostic Accuracy Study.

The fecal immunochemical test (FIT) is recommended for triaging primary care patients in England with low-risk symptoms of colorectal cancer (CRC). The evidence underpinning recommendations by the National Institute for Health and Care Excellence had limitations, with a paucity of primary care evidence. This study examines the diagnostic accuracy of FIT in a defined low-risk symptom primary care population. Consecutive symptomatic adult patients referred for a FIT between October and December 2019 were included. Patients were derived from 225 primary care practices in England. Serious colorectal diseases (CRC, high-risk polyps, and inflammatory bowel disease [IBD]) were identified through patient follow-up over 18 months, using both primary and secondary healthcare records. Performance characteristics of FIT are reported according to differing thresholds, including the currently recommended threshold of ≥10 μg hemoglobin per gram of feces (μg/g). A total of 3,506 patients were included in the final analysis. Of these, 708 had a positive FIT result (≥10 μg/g). The prevalence of CRC was 1.3%. FIT positivity declined from 20.2% to 5.8% and 4.5% at cutoffs of 10, 80, and 120 μg/g, respectively. The sensitivity of FIT at ≥10 μg/g to detect CRC was 91.1% (95% CI, 77.9%-97.1%); its specificity was 80.7% (95% CI, 79.3%-82.0%); the positive predictive value (PPV) was 5.8% (95% CI, 4.2%-7.8%); and the negative predictive value (NPV) was 99.9% (95% CI, 99.6%-99.95%). The area under the receiver operating characteristic curve was 0.93 (0.91-0.96). PPV and specificity increased, whereas sensitivity and NPV decreased when serious colorectal diseases (CRC, high-risk polyps, and IBD) were combined. Age, sex, socioeconomic deprivation, and anemia did not significantly influence FIT sensitivity on subgroup analysis. Utilization of FIT at a threshold ≥10 μg/g can safely triage patients with low-risk symptoms in primary care, with negative results effectively ruling out CRC.

Comment on " Positive fecal immunochemical test results are associated with non-colorectal cancer mortality".

Comment on " Positive fecal immunochemical test results are associated with non-colorectal cancer mortality".

A positive faecal immunochemical test result and its association with the incidence of rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis: an analysis of one-million national colorectal cancer screening programme results

BackgroundAccumulating evidence now indicates that the presence of faecal haemoglobin, in the absence of gastrointestinal bleeding, may be an indicator of systemic inflammation and is linked to the development of human diseases. We evaluated whether a positive faecal immunochemical test (FIT) is associated with the development of immune-mediated inflammatory diseases (IMIDs).MethodsData from the nationwide colorectal cancer screening programme from 2009 to 2013 were used. Participants (n=8,646,887) were divided into FIT (+) and FIT (-) groups by performing a 1:1 random sampling matched by age and sex. Participants with concurrent haemorrhoids, colorectal cancer (CRC), inflammatory bowel disease (IBD), and missed CRC and IBD were excluded using the colonoscopy results, ICD-10 codes, and the special exemption code (V code). Endpoints were the incidence of IMIDs (rheumatoid arthritis [RA], systemic lupus erythematosus [SLE], and psoriatic arthritis [PsA]) after FIT.ResultsOf the 1,044,955 eligible participants, 229,594 and 815,361 individuals were included in the FIT (+) and the FIT (−) groups, respectively. During the mean follow-up period of 7.59 years, a total of 7645 (incidence rate [IR] 9.56/10,000 person-years [PY]), 208 (IR 0.26/10,000 PY), and 101 (IR 0.13/10,000 PY) patients were diagnosed with RA, SLE, and PsA, respectively. An adjusted Cox analysis demonstrated that FIT positivity conferred a 1.16 (95% confidence interval [CI] 1.09–1.24, p<0.001) times greater risk of developing RA. Kaplan–Meier analysis in the 1:2 propensity-score matched population also confirmed these results (hazard ratio [HR] 1.18, 95% CI 1.10–1.27, p<0.001).ConclusionsPositive FIT is associated with increased risk of RA in the general population, corroborating that aberrancies of gut mucosa are associated with the development of IMIDs. Vigilant monitoring and early referral to a specialist upon medical suspicion is required in this population.Trial registrationRetrospectively registered.Graphical abstract

Colorectal cancer screening with fecal immunochemical testing: a community-based, cross-sectional study in average-risk individuals in Nigeria

The estimated incidence of colorectal cancer is rising in Nigeria, where most patients present with advanced disease. Earlier detection of colorectal cancer is a goal of the Nigerian National Cancer Control Plan, but the utility of fecal-based screening is unclear. This study aimed to assess the fecal immunochemical test as a colorectal cancer screening modality in average-risk individualS in Nigeria. A population-based, cross-sectional study of qualitative fecal immunochemical test-based colorectal cancer screening was done in asymptomatic, average-risk participants aged 45-75 years in three states in Nigeria (Osun, Kwara, and Lagos). Participants were invited to enrol using age-stratified and sex-stratified convenience sampling following community outreach. Exclusion criteria included a personal history of colorectal cancer or rectal bleeding in the previous 6 months, a first-degree relative with a known diagnosis of colorectal cancer, or a comorbidity that would preclude conscious sedation or general anesthesia. Participants with positive fecal immunochemical test results underwent colonoscopy, and the positive predictive value of fecal immunochemical testing for colorectal cancer and advanced adenomas (≥10 mm, tubulovillous or villous or high-grade dysplasia) was calculated. Data on demographics and acceptability of fecal immunochemical testing and colonoscopy were collected. Between January and April 2021, 2330 participants were enrolled in the study and received a fecal immunochemical test, which was returned by 2109 participants. 1677 participants tested negative and 432 tested positive. Of these 432 participants, 285 underwent a colonoscopy (235 showed no polyps or cancer, 47 had polyps identified, and three had colorectal cancer identified). Of the 47 participants who had polyps identified, 20 had advanced adenomas diagnosed. The median age was 57 years (IQR 50-63), 958 (41%) were male and 1372 (59%) were female, and 68% had at least a secondary-level education. Participants were evenly spread across wealth quintiles. The positivity rate of the fecal immunochemical test was 21% overall (432 of 2109; 95% CI 20-21%), 11% (51 of 455; 95% CI 10-12) in Lagos, 20% (215 of 1052; 95% CI 20-21) in Osun, and 28% (166 of 597; 95% CI 27-29) in Kwara. Among the patients with a positive fecal immunochemical test who completed colonoscopy, the positive predictive value for invasive colorectal cancer was 1·1% (95% CI 0·3-3·3), and 7·0% (4·5-10·8) for advanced adenoma. The acceptability of fecal immunochemical screening among participants was very high. Colorectal cancer screening with qualitative fecal immunochemical tests in Nigeria is feasible and acceptable to average-risk asymptomatic participants. However, the low positive predictive value for advanced neoplasia and high endoscopy burden investigating false positives suggests it might not be an appropriate screening tool in this setting. Thompson Family Foundation, Prevent Cancer Foundation, National Institutes of Health/National Cancer Institute Program Cancer Center.

Faecal occult blood loss accurately predicts future detection of colorectal cancer. A prognostic model

ObjectivesTo examine the prognostic potential of repeated faecal haemoglobin (F-Hb) concentration measurements in faecal immunochemical test (FIT)-based screening for colorectal cancer (CRC).DesignPrognostic model.SettingDutch biennial FIT-based screening programme during 2014–2018.Participants265 881...

Timely Colonoscopy After Positive Fecal Immunochemical Tests in the Veterans Health Administration: A Qualitative Assessment of Current Practice and Perceived Barriers.

INTRODUCTION:The Veterans Health Administration introduced a clinical reminder system in 2018 to help address process gaps in colorectal cancer screening, including the diagnostic evaluation of positive fecal immunochemical test (FIT) results. We conducted a qualitative study to explore the differences between facilities who performed in the top vs bottom decile for follow-up colonoscopy.METHODS:Seventeen semistructured interviews with gastroenterology (GI) providers and staff were conducted at 9 high-performing and 8 low-performing sites.RESULTS:We identified 2 domains, current practices and perceived barriers, and most findings were described by both high- and low-performing sites. Findings exclusive to 1 group mainly pertained to current practices, especially arranging colonoscopy for FIT-positive patients. We observed only 1 difference in the perceived barriers domain, which pertained to primary care providers.DISCUSSION:These results suggest that what primarily distinguishes high- and low-performing sites is not a difference in barriers but rather in the GI clinical care process. Developing and disseminating patient education materials about the importance of diagnostic colonoscopy, eliminating in-person precolonoscopy visits when clinically appropriate, and involving GI in missed colonoscopy appointments and outside referrals should all be considered to increase follow-up colonoscopy rates. Our study illustrates the challenges of performing a timely colonoscopy after a positive FIT result and provides insights on improving the clinical care process for patients who are at substantially increased risk for colorectal cancer.

Delivering colorectal cancer screening integrated with primary health care services in Morocco: Lessons learned from a demonstration project.

Colorectal cancer (CRC) incidence and mortality rates are increasing rapidly in many low-income and middle-income countries. A demonstration project was implemented in Morocco in collaboration with the Ministry of Health to assess the feasibility, acceptability, and challenges of implementing CRC screening through routine primary care facilities. The objective of the project was to screen 10,000 men and women aged 50 to 75 years through 10 primary health centers (PHCs) in 2 provinces. All eligible men and women attending the selected PHCs were offered the fecal immunochemical test (FIT). Stool specimens brought to the PHCs were tested immediately by trained nurses. FIT-positive individuals were referred to the National Oncology Institute for colonoscopy. In total, 9763 eligible men and women were screened by FIT between June 2017 and May 2019; most (73.3%) were women. The test was positive in 460 participants (4.7%). Among the individuals who had positive FIT results, 62.6% underwent colonoscopy. The main reasons for noncompliance to colonoscopy were competing life priorities (15.4%), other health problems (13%), and fear of getting a cancer diagnosis (12.3%). As the number of referrals to colonoscopy increased, the waiting time for the procedure increased, resulting in a drop in compliance. The detection rates of advanced adenomas and CRC were 4.0 in 1000 and 0.5 in 1000 individuals screened, respectively. An effective strategy to reach the target populations (especially men), a pragmatic assessment of the health system's capacity to deal with large numbers of referrals, and a formal cost-effectiveness analysis are essential before making any decision to introduce CRC screening in Morocco.

Risk of Diabetes in Subjects with Positive Fecal Immunochemical Test: A Nationwide Population-Based Study.

Background Positive fecal immunochemical test (FIT) results have been recently suggested as a risk factor for systemic inflammation. Diabetes induces inflammation in the gastrointestinal tract via several ways. We investigated the association between FIT results and the incidence of diabetes.Methods A total of 7,946,393 individuals aged ≥50 years from the National Cancer Screening Program database who underwent FIT for colorectal cancer (CRC) screening from 2009 to 2012 were enrolled. The primary outcome was newly diagnosed diabetes based on the International Classification of Disease 10th revision codes and administration of anti-diabetic medication during the follow-up period.Results During a mean follow-up of 6.5 years, the incidence rates of diabetes were 11.97, 13.60, 14.53, and 16.82 per 1,000 personyears in the FIT negative, one-positive, two-positive, and three-positive groups, respectively. The hazard ratios (HRs) for the incidence of diabetes were 1.14 (95% confidence interval [CI], 1.12 to 1.16; HR, 1.21; 95% CI, 1.16 to 1.27; and HR, 1.40; 95% CI, 1.28 to 1.55) in the one-positive, two-positive, and three-positive FIT groups compared with the FIT negative group, respectively. The effect was consistent in individuals with normal fasting blood glucose (adjusted HR 1.55 vs. 1.14, P for interaction <0.001).Conclusion Positive FIT results were associated with a significantly higher risk of diabetes, suggesting that the FIT can play a role not only as a CRC screening tool, but also as a surrogate marker of systemic inflammation; thus, increasing the diabetes risk.

S263 Role of Demographics in Non-Invasive Testing for Colorectal Cancer Screening: Do Targeted Cut-Off Values Improve Detection?

Introduction: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. For those unable or unwilling to undergo invasive screening, fecal immunochemical test (FIT) is a yearly alternative due to its cost and accessibility compared to the Cologuard. Few studies have examined how patient factors influence FIT outcomes. This study aims to determine whether FIT should be interpreted within the context of patient demographics and medical history. Methods: A retrospective review of patients >50 years old who had a FIT followed by a colonoscopy within 1 year from 2016-2019 was performed. Patients were analyzed based on age, race, body mass index (BMI), comorbidities, smoking, and alcohol use. FIT values above 100 ng/mL were positive based on manufacturer recommendations (Polymedco, NY). Chi-square test was used to compare positive FIT rates within each of the patient demographics and medical history. Fisher’s exact test was used when sparse cells were encountered in contingency tables. False positive (FP) and negative (FN) FIT results were determined by comparing with the gold standard of colonoscopy. Results: 1025 patients were reviewed. 21.8% of FIT results were positive. Factors which differed in positive FIT rates were age (P = 0.003), smoking (P < 0.001), alcohol (P = 0.001), and hypertension (P < 0.001). A significant trend was noted with increasing positive findings with older age (Cochran-Armitage test, P = 0.001). The difference in rates of FP and FN FIT outcomes among each variable underwent further sub-analysis. The FP rate was 66.8% and the FN rate was 12.8%. Higher FN outcomes were noted in those above the age of 70, males and smokers, though the result was only statistically significant for males (P = 0.009). Females were observed to have higher FP rates than males (P = 0.019). African Americans had the highest rates of a positive FIT overall, and the FN rates were the lowest; neither result was statistically significant. Patients on aspirin and with a history of alcohol use had higher FP rates but did not meet statistical significance. Conclusion: Females were found to have higher FP FIT rates compared to males indicating that patient demographics may influence the FIT outcome. We can use this information to identify populations at higher risk of FP or FN FIT outcomes to target CRC screening. Additionally, recalculating the FP and FN rates for each variable by adjusting FIT cutoff may help determine new FIT targets to better improve sensitivity and specificity.Table 1.: Patient characteristics and fecal immunochemical test (FIT) positive rates.

Positive fecal immunochemical test results are associated with non-colorectal cancer mortality.

Background/AimsStudies have reported an association between fecal occult blood and increased all-cause, non-colorectal cancer (CRC) as well as CRC mortality. This study aimed to determine whether positive fecal immunochemistry test (FIT) results are associated with death from various causes in the South Korean population.MethodsUsing the Korean National Cancer Screening Program database, we collected data on patients who underwent FIT between 2009 and 2011.ResultsOf the 5,932,544 participants, 380,789 (6.4%) had positive FIT results. FIT-positive participants had a higher mortality rate than FIT-negative participants from CRC (1.33 and 0.21 per 1,000 person-years, p < 0.001, respectively) and non-CRC causes (10.40 and 7.50 per 1,000 person-years, p < 0.001, respectively). Despite adjusting for age, sex, smoking status, alcohol consumption habits, body mass index, comorbidity, and aspirin use, FIT positivity was associated with an increased risk of dying from all non-CRC causes (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.15 to 1.18) and CRC (aHR, 5.61; 95% CI, 5.40 to 5.84). Additionally, FIT positivity was significantly associated with increased mortality from circulatory disease (aHR, 1.14; 95% CI, 1.11 to 1.17), respiratory disease (aHR, 1.14; 95% CI, 1.09 to 1.19), digestive disease (aHR, 1.57; 95% CI, 1.48 to 1.66), neuropsychological disease (aHR, 1.08; 95% CI, 1.01 to 1.16), blood and endocrine diseases (aHR, 1.10; 95% CI, 1.04 to 1.17), and external factors (aHR, 1.16; 95% CI, 1.11 to 1.20).ConclusionsPositive FIT results are associated with an increased risk of mortality from CRC and various other chronic diseases, suggesting that it could be a predictor of mortality independent of its association with CRC.

P-211 Risk of diabetes in subjects with positive fecal immunochemical test: A nationwide population-based study

Positive fecal immunochemical test (FIT) results in addition to colorectal cancer (CRC) screening have been recently suggested as a risk factor for systemic inflammation. Diabetes induces inflammation in the gastrointestinal tract, but the etiology is unclear. We investigated the association between FIT results and the incidence of diabetes. A total of 7,946,393 individuals aged ≥ 50 years from the National Cancer Screening Program database who underwent FIT for CRC screening from January, 2009 to December, 2012 were enrolled. The primary outcome was newly diagnosed diabetes based on the International Classification of Disease 10th revision codes and administration of anti-diabetic medication during the follow-up period. During a mean follow-up of 6.5 years, the incidence rates of diabetes were 11.97, 13.60, 14.53, and 16.82 per 1,000 person-years in the FIT negative, one-positive, two-positive, and three-positive groups, respectively. The hazard ratios (HRs) for the incidence of diabetes were 1.14 [95% confidence interval (CI) 1.12–1.16], 1.21; 95% CI 1.16–1.27, and 1.40; 95% CI 1.28–1.55] in the one-positive, two-positive, and three-positive FIT groups compared with the FIT negative group, respectively. The effect was consistent in individuals without dyslipidemia [adjusted hazard ratio (aHR) 1.50 vs. 1.10, p for interaction = 0.002] and those with normal fasting blood glucose (aHR 1.60 vs. 1.12, p for interaction < 0.001). Positive FIT results were associated with a significantly higher risk of diabetes, suggesting that the FIT can play a role not only as a CRC screening tool, but also as a surrogate marker of systemic inflammation; thus, increasing the diabetes risk.

False-positive fecal immunochemical test results in colorectal cancer screening and gastrointestinal drug use.

The study aimed to determine the influence of drug treatments (proton pump inhibitors [PPIs] combined with other drugs) on the false-positive (FP) rate in the fecal immunochemical test (FIT). Patients undergoing colonoscopy in the setting of a CRC screening program due to a positive FIT result were included prospectively. Demographic data and drug intake of PPIs, antiplatelet therapy (APA), anticoagulants, selective serotonin reuptake inhibitors (SSRIs), and nonsteroidal anti-inflammatory drugs (NSAIDs) were collected. An FP FIT result was considered normal colonoscopy or with nonneoplastic pathology (NNP). Logistic regression models were used to evaluate the effect of these drugs on the rate of FP FIT results. We included 515 patients, and 59% (304/515) were males. The rate of FP FIT results was 48% (249/515). Study drug use was higher in patients > 60 years old and females than in those < 60 years old and males (p < 0.001 and p = 0.049, respectively). Multivariate logistic regression revealed that female sex (OR = 2.7 95% CI 1.9-3.9), NNP (OR = 1.5 95% CI 1.1-2.2), and the use of any of the study drugs (OR = 1.4 95% CI 0.9-2.0) were independent risk factors for FP FIT results. The risk of FP FIT results was significantly higher in PPI users than in nonusers (OR = 1.8 95% CI 1.1-2.9), specifically when PPIs were combined with other drugs (OR = 2.01 95% CI 1.1-3.6) only in men. Female sex, NNP, and PPIs combined with other drugs in males were identified as independent risk factors for FP FIT results.