Cancer Res Treat.  2018 Jan;50(1):50-59. 10.4143/crt.2017.027.

Risk and Characteristics of Postcolonoscopy Interval Colorectal Cancer after a Positive Fecal Test: A Nationwide Population-Based Study in Korea

• Lee CK
• Choi KS
• Eun CS
• Park DI
• Han DS
• Yoon M
• Suh M
• Jun JK

• KMID: 2403474
• DOI: http://doi.org/10.4143/crt.2017.027

Abstract

PURPOSE
Fecal tests remain a mainstay of population-based colorectal cancer (CRC) screening programs worldwide. However, data on interval CRC (iCRC) arising after follow-up colonoscopy of a positive fecal test are scarce. We conducted a nationwide population-based study to reveal the risk and characteristics of iCRC in this setting.
MATERIALS AND METHODS
We searched the National Cancer Screening Program for CRC database in Korea (2005-2010). Incidence of iCRC within the program was estimated, then Cox proportional-hazards regression analysis was performed to determine the independent predictors of iCRC. The clinical characteristics of iCRC were compared with screen-detected CRC (sCRC).
RESULTS
We identified 280 iCRC among 150,660 negative colonoscopies as a follow-up exam to a positive fecal immunochemical test (FIT), and 2,427 sCRC. The overall incidence of iCRC was 0.49/1,000 person-years (95% confidence interval [CI], 0.48 to 0.51). iCRC was more likely to occur in men (adjusted hazard ratio [aHR], 1.79; 95% CI, 1.39 to 2.30) and elderly patients (aHR, 1.77; 95% CI, 1.38 to 2.28 in 65-74 years; aHR, 3.13, 95% CI, 2.13 to 4.60 in ≥ 75 years). The National Quality Improvement Program for colonoscopy reduced a short-term risk of iCRC (aHR, 0.48; 95% CI, 0.27 to 0.87). Compared with sCRC, iCRC was more likely to occur in the proximal colon, be diagnosed at the localized stage, and have a lower CRC mortality (32.7 vs. 17.4%, 56.8 vs. 34.1%, and 12.5 vs. 17.7%, respectively; all p < 0.05).
CONCLUSION
In a population-based CRC screening program with FIT, the burden of iCRC after follow-up colonoscopy was substantial. Men and elderly patients possess a significantly higher risk of iCRC.

Keyword

Colonoscopy; Colorectal neoplasms; Early detection of cancer

MeSH Terms

Aged
Colon
Colonoscopy
Colorectal Neoplasms*
Early Detection of Cancer
Follow-Up Studies
Humans
Incidence
Korea*
Male
Mass Screening
Mortality
Quality Improvement

Figure

• 

  Fig. 1. Flow chart of the study population and case identification. NCSP, National Cancer Screening Program; CRC, colorectal cancer; FIT, fecal immunochemical test.

• 

  Fig. 2. A time trend of interval colorectal cancer (iCRC) rates since index colonoscopy.

Reference

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