Post-colonoscopy colorectal cancers in a national FIT-based CRC screening program.

BACKGROUND AND STUDY AIMS

Post-colonoscopy colorectal cancers (PCCRCs) decrease the effect of colorectal cancer (CRC) screening programs. To enable PCCRC incidence reduction on the long-term we classified PCCRCs diagnosed after colonoscopies performed in a fecal immunochemical test (FIT-) based screening program.

PATIENTS AND METHODS

PCCRCs diagnosed after colonoscopies performed between 2014-2016 for positive FIT in the Dutch CRC screening program were included. PCCRCs were categorized according to the World Endoscopy Organization consensus statement into a) interval PCCRC (diagnosed before the recommended surveillance), b) non-interval-type-A (diagnosed at the recommended surveillance interval), c) non-interval-type-B (diagnosed after the recommended surveillance interval), or d) non-interval-type-C (diagnosed after the intended recommended surveillance interval, but not applied due to comorbidity). The most probable etiology was determined by root-cause analysis. Tumor stage distributions were compared between categories.

RESULTS

116,362 colonoscopies were performed after positive FIT with 9,978 screen-detected CRCs. During follow-up, 432 PCCRCs were diagnosed. The 3-year PCCRC rate was 2.7%. PCCRCs were categorized as interval (53.5%), non-interval-type-A (14.6%), non-interval-type-B (30.6%), and non-interval-type-C (1.4%). Interval PCCRCs had as most common etiology a possible missed lesion with adequate examination (73.6%) and were more often diagnosed at an advanced stage (stage III/IV, 53.2%) compared to non-interval-type-A (15.9%, p<0.001) and non-interval-type-B (40.9%, p=0.025) PCCRCs.

CONCLUSIONS

The 3-year PCCRC rate was low in this FIT-based CRC screening program. Approximately half of PCCRCs were interval PCCRCs. These were mostly caused by missed lesions and were diagnosed at more advanced stage. This emphasizes the importance of high-quality colonoscopy with optimal polyp detection.

Informations de copyright

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Déclaration de conflit d'intérêts

PW received consulting fees from the National Institute for Public Health and Environment for the evaluation of biobank development for storage of sample devices of participants of Dutch colorectal cancer screening program. GAM is co-founder and board member (CSO) of CRCbioscreen BV, he has a research collaboration with CZ Health Insurances (cash matching to ZonMW grant) and he has research collaborations with Exact Sciences, Sysmex, Sentinel Ch. SpA, Personal Genome Diagnostics (PGDX), DELFi and Hartwig Medical Foundation; these companies provide materials, equipment and/or sample/ genomic analyses. ED has endoscopic equipment on loan of Olympus and FujiFilm, and received a research grant from FujiFilm. She has received honorarium for consultancy from FujiFilm, Tillots, Olympus, GI Supply, Cancer Prevention Pharmaceuticals, PAION and Ambu, and speakers’ fees from Olympus, Roche, GI Supply, Norgine, IPSEN, PAION and FujiFilm. MCWS has received research support from: Sentinel, Sysmex, Norgine, and Medtronic. The other authors reported no conflicts of interest.