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Association of Negative Faecal Immunochemical Test Results With the Risk of Advanced Neoplasia
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This retrospective cohort study assessed the relationship between the number of rounds of faecal immunochemical tests (FITs) with negative results and the risk for advanced neoplasia. The study included 3369 above average–risk (a prior history of adenoma or family history of colorectal cancer) individuals (age, 50 to 74 years) undergoing surveillance colonoscopy who had completed a 2-sample FIT between colonoscopies at 1 to 2–year intervals. The incidence of advanced neoplasia in the cohort decreased with increasing number of rounds of FIT with negative results. The presence of multiple rounds of FITs with negative results was associated with a low risk of advanced neoplasia at follow-up colonoscopy within 2 years.
- This study shows that multiple rounds of FIT is a reasonably safe approach to colorectal cancer surveillance in above average–risk patients without neoplasia or nonadvanced adenoma at prior colonoscopy.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND & AIMS
In above-average risk individuals undergoing colonoscopy-based surveillance for colorectal cancer (CRC), screening with fecal immunochemical tests (FIT) between colonoscopies might facilitate personalization of surveillance intervals. Since a negative FIT is associated with a reduced risk for CRC, we examined the relationship between number of rounds of negative FIT and risk for advanced neoplasia in individuals undergoing surveillance colonoscopy.
METHODS
We conducted a retrospective cohort study on 4021 surveillance intervals in 3369 individuals (50-74y), who had completed a 2-sample FIT between colonoscopies, from 1 to 4 rounds at 1-2 yearly intervals, each with a negative result (<20μg hemoglobin/g faeces). Incidence of advanced neoplasia (CRC or advanced adenoma) was determined at the follow-up colonoscopy. Competing-risk regression was used to assess the association between multiple negative FIT results and the risk of advanced neoplasia within 2y.
RESULTS
The incidence of advanced neoplasia in the cohort was 9.9% and decreased with increasing numbers of rounds of negative FIT results: 11.1% after one negative FIT to 5.7% after four negative FIT. The risk of advanced neoplasia was significantly lower in participants with three (Subdistribution Hazard Ratio (SHR), 0.50; 95% CI 0.24-0.97), and four (SHR, 0.33; 95% CI, 0.15-0.73) rounds of negative FIT compared with only one negative FIT.
CONCLUSIONS
There was a low risk of advanced neoplasia after multiple rounds of negative FIT in above average-risk people undergoing surveillance with no neoplasia or nonadvanced adenoma at prior colonoscopy. This supports the use of interval FIT to personalize surveillance by lengthening colonoscopy intervals following multiple negative FIT results.
Additional Info
Multiple negative faecal immunochemical tests reduce risk of advanced neoplasia in a colonoscopy surveillance program
Clin. Gastroenterol. Hepatol. 2023 Jan 04;.(.)., MM Wassie, GP Young, JM Winter, C Cock, P Bampton, M Rahman, R Heddle, R Fraser, R Meng, EL SymondsFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.