Interval Cancer After Negative Follow-Up Colonoscopy Within A Fit Based CRC Screening Program

Aims After a positive fecal immunochemical test (FIT), participants of the Dutch colorectal cancer (CRC) screening program are referred for a follow-up colonoscopy. In case no relevant findings are detected, participants are re-invited for FIT screening after 10 years. However, there is limited data about the risk of developing CRC in this period.

Methods Data were extracted from the Dutch national screening information system. Participants who underwent a follow-up colonoscopy between 2014 and 2018 without relevant findings and/or with referral back to the screening program were selected. CRC diagnoses were validated and only diagnoses at least 180 days after negative colonoscopy were considered. Because of the large number of selected participants, negative colonoscopies were randomly validated to assess whether they were correctly qualified as negative. Main outcome was the CRC risk after negative colonoscopy, which was compared with CRC risk after negative FIT (cut-off at 47 µg hemoglobin/g feces and 2-year interval after negative test result).

Results A total of 42,160 participants was selected. After validation, 35,052 participants remained, of which 24 had a validated post-colonoscopy interval CRC. This resulted in a CRC risk after negative colonoscopy of 6.8 per 10,000 participants after an average follow-up of 1.6 years. In comparison, CRC risk after negative FIT was 11.28 per 10,000 participants after an average follow-up period of 2.0 years. CRC risk after negative colonoscopy per 10,000 person years of follow-up after 2.5 years was approximately equal to CRC risk after negative FIT per 10,000 person years of follow-up after 2 years.

Conclusions Risk of post-colonoscopy interval CRC after an average follow-up of 1.6 years in a FIT based screening program is low. However, the 10-year interval used in the Netherlands after a negative follow-up colonoscopy may have to be reconsidered, although data is limited at this point.

Citation: van de Schootbrugge-Vandermeer H, Kooyker A, Nagtegaal I et al. OP233 INTERVAL CANCER AFTER NEGATIVE FOLLOW-UP COLONOSCOPY WITHIN A FIT BASED CRC SCREENING PROGRAM. Endoscopy 2021; 53: S95.

Publication History

Article published online:
19 March 2021