Association between time to colonoscopy after a positive guaiac fecal test result and risk of colorectal cancer and advanced stage disease at diagnosis

Amani Beshara, Maya Ahoroni, Doron Comanester, Alex Vilkin, Doron Boltin, Iris Dotan, Yaron Niv, Arnon D. Cohen, Zohar Levi

Research output: Contribution to journalArticlepeer-review

Abstract

We evaluated time to colonoscopy after a positive guaiac-based fecal occult blood test (gFOBT) result and its association with the risk of overall colorectal cancer (CRC) and advanced-stage disease at diagnosis. We conducted a retrospective cohort study (2011–2013) within the Clalit Health Services, Israel. Participants were patients between 50 and 74 years old with a positive gFOBT result who had follow-up colonoscopies within 24 months. The exposure was time to colonoscopy, and the main outcome measure was a risk for overall and advanced CRC (defined as Stages III–IV). Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for patient demographics and baseline risk factors. Of the 17,958 patients with positive gFOBT results (median age, 61 years [interquartile range, 56–67 years]; women, 52.2%), there were 685 cases of CRC and 156 cases of an advanced-stage disease diagnosed. The rate of cancer diagnosis at 0–3, 4–6, 7–9, 10–12 and 13–24 months was 3.9%, 2.5%, 3.5%, 4.2% and 7.3%, respectively (p < 0.001). Compared to colonoscopy follow-up within 0–3 months, risks for any CRC and advanced stage disease were higher for a follow-up of 12–24 months: OR, 1.97 (95% CI, 1.51–2.56) and 1.88 (95% CI, 1.43–2.46), respectively. For right-sided cancer (n = 194), an increased risk starts at 10 months, OR, 1.91 (95% CI 1.03–3.56). A result of 3–6 positive fields was significantly associated diagnosis of cancer (OR, 5.52; 95% CI, 4.71–6.46) and advanced stage disease (OR, 8.07; 95% CI, 5.74–11.36). Encouraging an early uptake of colonoscopy and targeting those with 10–24 months delay and a 3–6 positive fields is warranted.

Original languageEnglish
Pages (from-to)1532-1540
Number of pages9
JournalInternational Journal of Cancer
Volume146
Issue number6
DOIs
StatePublished - 15 Mar 2020

Keywords

  • positive fecal occult blood test
  • risk of colorectal cancer
  • time to colonoscopy

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