title: Interval fecal immunochemical testing in a colonoscopic surveillance program speeds detection of colorectal neoplasia.
abstract: OBJECTIVE
  Rapidly progressing or missed lesions can reduce the effectiveness of colonoscopy-based colorectal cancer surveillance programs. We investigated whether giving fecal immunochemical tests (FITs) for hemoglobin between surveillance colonoscopies resulted in earlier detection of neoplasia.
  
  
  METHODS
  The study included 1736 patients with a family history or past neoplasia; they received at least 2 colonoscopy examinations and were followed for a total of 8863 years. Patients were excluded from the study if they had genetic syndromes, colorectal surgery, or inflammatory bowel disease. An FIT was offered yearly, in the interval between colonoscopies; if results were positive, the colonoscopy was performed earlier than scheduled.
  
  
  RESULTS
  Among the 1071 asymptomatic subjects (61%) who received at least 1 FIT, the test detected 12 of 14 cancers (86% sensitivity) and 60 of 96 (63%) advanced adenomas. In patients with positive results from the FIT, the diagnosis of cancer was made 25 months (median) earlier and diagnosis of advanced adenoma 24 months earlier. Patients who had repeated negative results from FIT had an almost 2-fold decrease in risk for cancer and advanced adenoma compared with patients who were not tested (5.5% vs 10.1%, respectively, P = .0004). The most advanced stages of neoplasia, observed across the continuum from nonadvanced adenoma to late-stage cancer, were associated with age (increased with age), sex (increased in males), and FIT result. The probability of most advanced neoplastic stage was lowest among those with a negative result from the FIT (odds ratio, 0.68; P < .001).
  
  
  CONCLUSIONS
  Interval examinations using the FIT detected neoplasias sooner than scheduled surveillances. Subjects with negative results from the FIT had the lowest risk for the most advanced stage of neoplasia. Interval FIT analyses can be used to detect missed or rapidly developing lesions in surveillance programs.
authors: Flinders Centre for Cancer Prevention and Control, Flinders University of South Australia, Bedford Park (Adelaide), South Australia.
authors: Joanne M
authors: JM
authors: Lane
authors: Elizabeth
authors: E
authors: Chow
authors: Graeme P
authors: GP
authors: Young
authors: Norm
authors: N
authors: Good
authors: Alicia
authors: A
authors: Smith
authors: Jeff
authors: J
authors: Bull
authors: Jayne
authors: J
authors: Sandford
authors: Joylene
authors: J
authors: Morcom
authors: Peter A
authors: PA
authors: Bampton
authors: Stephen R
authors: SR
authors: Cole
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005243:Feces / Q000737:chemistry*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007120:Immunochemistry / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D009780:Occult Blood; D011159:Population Surveillance / Q000379:methods; D016016:Proportional Hazards Models
chemical_list: D006454:Hemoglobins