title: Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality: analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program.
abstract: Interval colorectal cancer (CRC) after colonoscopy may affect effectiveness and cost-effectiveness of screening programmes. We aimed to investigate whether and how faecal haemoglobin concentration (FHbC) of faecal immunochemical testing (FIT) affected the risk prediction of interval cancer (IC) caused by inadequate colonoscopy quality in a FIT-based population screening programme.
  
  
  
  From 2004 to 2009, 29 969 subjects underwent complete colonoscopy after positive FIT in the Taiwanese Nationwide CRC Screening Program. The IC rate was traced until the end of 2012. The incidence of IC was calculated in relation to patient characteristics, endoscopy-related factors (such adenoma detection rate (ADR)) and FHbC. Poisson regression analysis was performed to assess the potential risk factors for colonoscopy IC.
  
  
  
  One hundred and sixty-two ICs developed after an index colonoscopy and the estimated incidence was 1.14 per 1000 person-years of observation for the entire cohort. Increased risk of IC was most remarkable in the uptake of colonoscopy in settings with ADR lower than 15% (adjusted relative risk (aRR)=3.09, 95% CI 1.55 to 6.18) and then higher FHbC (μg Hb/g faeces) (100-149: aRR=2.55, 95% CI 1.52 to 4.29, ≥150: aRR=2.74, 95% CI 1.84 to 4.09) with adjustment for older age and colorectal neoplasm detected at baseline colonoscopy. Similar findings were observed for subjects with negative index colonoscopy.
  
  
  
  Colonoscopy ICs arising from FIT-based population screening programmes were mainly influenced by inadequate colonoscopy quality and independently predicted by FHbC that is associated with a priori chance of advanced neoplasm. This finding is helpful for future modification of screening logistics based on FHbC.
authors.affiliation: Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Sherry Yueh-Hsia
authors.initials: SY
authors.lastname: Chiu
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chuang
authors.affiliation: School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Sam Li-Sheng
authors.initials: SL
authors.lastname: Chen
authors.affiliation: School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Amy Ming-Fang
authors.initials: AM
authors.lastname: Yen
authors.affiliation: Department of Health Industry Management, School of Healthcare Management, Kainan University, Tao-Yuan, Taiwan.
authors.forename: Jean Ching-Yuan
authors.initials: JC
authors.lastname: Fann
authors.affiliation: Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Dun-Cheng
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.affiliation: Division of Gastroenterology and Hepatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: Chu-Kuang
authors.initials: CK
authors.lastname: Chou
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wen-Feng
authors.initials: WF
authors.lastname: Hsu
authors.affiliation: Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan.|Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shu-Ti
authors.initials: ST
authors.lastname: Chiou
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Chiu
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000368:Aged; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005243:Feces / Q000737:chemistry*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007120:Immunochemistry; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011237:Predictive Value of Tests; D015397:Program Evaluation; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology
chemical_list: D006454:Hemoglobins
keywords: COLONOSCOPY; COLORECTAL CANCER; COLORECTAL CANCER SCREENING; COLORECTAL NEOPLASIA; SCREENING