Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;12(10):11816-11827.
doi: 10.1002/cam4.5850. Epub 2023 Mar 23.

Postponing colonoscopy for 6 months in high-risk population increases colorectal cancer detection in China

Mingqing Zhang  1   2   3   4 , Yongdan Zhang  2   3 , Wen Zhang  5 , Lizhong Zhao  2   3 , Haoren Jing  2   3 , Xiaojing Wu  4 , Lu Guo  5 , Haixiang Zhang  5 , Yong Zhang  5 , Siwei Zhu  1   2   3   4 , Shiwu Zhang  4   6 , Xipeng Zhang  1   2   3   4
Affiliations

Postponing colonoscopy for 6 months in high-risk population increases colorectal cancer detection in China

Mingqing Zhang et al. Cancer Med. 2023 May.

Abstract

Background and aims: Colonoscopy is an important colorectal cancer (CRC) screening modality; however, not all high-risk groups identified by fecal immunochemical test (FIT) and/or high-risk factor questionnaire (HRFQ) undergo colonoscopy in time. The impact of delays in colonoscopy on CRC detection among high-risk populations remains poorly understood, warranting further clarification.

Methods: A retrospective study was conducted among CRC high-risk population identified by Tianjin CRC screening program. According to the colonoscopy results after HRFQ and FIT, patients were classified into CRC, advanced adenoma, non-advanced adenoma, and normal groups. The time interval between CRC screening and colonoscopy was investigated and its relationship with colonoscopy results. Logistic regression was performed to explore the risk factors of CRC detection.

Results: Among the high-risk population without a history of CRC or polyps, 49,810 underwent HRFQ, FIT, and colonoscopy, and a time interval of fewer than 6 months was found for 79.56% of patients (n = 39,630). People with positive FIT were more likely to undergo colonoscopy within 6 months, and detection rates of CRC and/or advanced adenoma were positively related to time intervals. Similar results were found in people with a negative FIT but positive HRFQ. A time interval longer than 6 months was a significant predictor of CRC detection in high-risk populations.

Conclusion: For high-risk people identified by CRC screening, especially those with a positive FIT, a time interval of 6 months was associated with an increased probability of CRC detection. Our findings emphasize that populations at high risk should undergo colonoscopy at least within 6 months.

Keywords: cancer prevention; colonoscopy; colorectal cancer; colorectal cancer screening.

PubMed Disclaimer

Conflict of interest statement

The authors disclose no conflicts.

Figures

FIGURE 1
FIGURE 1
Detection of colorectal cancer, advanced adenoma and non‐advanced adenoma in patients awaiting colonoscopy after identified as high‐risk population.
FIGURE 2
FIGURE 2
Time to colonoscopy after identified as high‐risk population and adjusted incidence of CRC (A), advanced adenoma (B), non‐advanced adenoma (C).
FIGURE 3
FIGURE 3
Time to colonoscopy after identified as high‐risk population and adjusted incidence of advanced‐stage colorectal cancer (A), early‐stage CRC (B). CI, confidence interval. The model was adjusted for age, gender, education, occupation, residence, FIT, history of chronic diarrhea, history of chronic constipation, history of bloody mucous stools, history of chronic appendicitis or appendectomy, history of chronic cholecystitis or gallstones, adverse life events, history of cancer, and a first‐degree relative with CRC. A full analysis set was used for the CRC model, while 1328 CRC cases were excluded in the advanced adenoma model, and an additional 3150 advanced adenoma cases were excluded in the non‐advanced adenoma model.
FIGURE 4
FIGURE 4
Detection of colorectal cancer, advanced adenoma and non‐advanced adenoma in positive (solid line) and negative (dotted line) fecal immunochemical test patients, according to the time interval for colonoscopy after identified as high‐risk population.
FIGURE 5
FIGURE 5
Time to colonoscopy after a positive fecal immunochemical test (FIT) (A), negative FIT (B) and the adjusted incidence of colorectal cancer.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

References

    1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209‐249. doi:10.3322/caac.21660 - DOI - PubMed
    1. Zorzi M, Fedeli U, Schievano E, et al. Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test. Gut. 2015;64(5):784‐790. doi:10.1136/gutjnl-2014-307508 - DOI - PubMed
    1. Force USPST , Bibbins‐Domingo K, Grossman DC, et al. Screening for colorectal cancer: US preventive services task Force recommendation Statement. JAMA. 2016;315(23):2564‐2575. doi:10.1001/jama.2016.5989 - DOI - PubMed
    1. Choi KS, Lee HY, Jun JK, Shin A, Park EC. Adherence to follow‐up after a positive fecal occult blood test in an organized colorectal cancer screening program in Korea, 2004‐2008. J Gastroenterol Hepatol. 2012;27(6):1070‐1077. doi:10.1111/j.1440-1746.2011.06944.x - DOI - PubMed
    1. Libby G, Fraser CG, Carey FA, Brewster DH, Steele RJC. Occult blood in faeces is associated with all‐cause and non‐colorectal cancer mortality. Gut. 2018;67(12):2116‐2123. doi:10.1136/gutjnl-2018-316483 - DOI - PMC - PubMed

Publication types