Detection of colorectal cancer and advanced neoplasia during first surveillance interval after detection of adenomas in fecal immunochemical test cancer screening: a nationwide study

Abstract

Background Adenoma surveillance guidelines are based on non-fecal immunochemical test (FIT)-based screening settings. However, colorectal cancer (CRC) risk may be different in FIT-positive screening populations. We evaluated the CRC and advanced adenoma risk within the recommended surveillance periods in the Danish FIT-based CRC screening program for participants with intermediate or high risk adenomas according to 2010 European guidelines. Furthermore, we estimated CRC risk for those who were not recommended surveillance according to European Society of Gastrointestinal Endoscopy (ESGE) 2020 guidelines.

Methods Using nationwide health registries, we identified 17 936 FIT-screening participants from 2014–2017 with adenomas undergoing surveillance (high risk 1 year, intermediate risk 3 years). Participants with a follow-up examination were included (N = 10 068). Relative risk (RR) of CRC and advance adenoma was compared between intermediate and high risk groups and between intermediates who were recommended surveillance (S) or no surveillance (NS) according to 2020 ESGE guidelines.

Results During surveillance, CRC occurred in 0.59% of the high risk group and 1.11% of the intermediate risk group (RR 0.53 [95%CI 0.34–0.84]). The high risk group had a 24% increased risk of advanced adenoma. CRC occurred in 1.69% of the intermediateNS group and 0.87% of the intermediateS group (RR 1.94 [95%CI 1.18–3.21]), and RR for advanced adenoma was 1.19 (95%CI 1.03–1.37).

Conclusion CRC detection was lower among participants rated at higher risk at initial CRC screening. Findings at first screen-derived colonoscopy might not be as good a predictor of CRC risk in a FIT-positive screening population.

• References

• 1 Mandel JS, Bond JH, Church TR. et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med 1993; 328: 1365-1371
• 2 Kronborg O, Fenger C, Olsen J. et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996; 348: 1467-1471
• 3 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
• 4 Council of the European Union. Council recommendation of 2 December 2003 on cancer screening. Official Journal of the European Union 2003; 327: 34-38
• 5 Senore C, Basu P, Anttila A. et al. Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report. Gut 2019; 68: 1232-1244
• 6 Cardoso R, Guo F, Heisser T. et al. Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study. Lancet Oncol 2021; 22: 1002-1013
• 7 Zorzi M, Fedeli U, Schievano E. et al. Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test. Gut 2015; 64: 784-790
• 8 Njor SH, Larsen MB, Søborg B. et al. Colorectal cancer mortality after randomized implementation of FIT-based screening – a nationwide cohort study. J Med Screen 2022; 29: 241-248
• 9 Parker J, Gupta S, Torkington J. et al. Comparison of recommendations for surveillance of advanced colorectal polyps: a systematic review of guidelines. J Gastroenterol Hepatol 2023; 38: 854-864
• 10 Hassan C, Antonelli G, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – update 2020. Endoscopy 2020; 52: 687-700
• 11 Rutter MD, East J, Rees CJ. et al. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut 2020; 69: 201-223
• 12 Rasmussen M, Ingeholm P, Linnemann D. et al. Screenings- og adenomkontrol program for tyk- og endetarmskræft [Screening and adenoma control program for colon and rectal cancer]. Accessed June 04, 2024 at: https://danskpatologi.org/wp-content/uploads/2016/02/Screenings-og-adenomkontrol-program-tyk-og-endtarmskr%C3%A6ft.pdf
• 13 von Karsa L, Patnick J, Segnan N. et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013; 45: 51-59
• 14 Gupta S, Lieberman D, Anderson JC. et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 91: 463-485.e465
• 15 Click B, Pinsky PF, Hickey T. et al. Association of colonoscopy adenoma findings with long-term colorectal cancer incidence. JAMA 2018; 319: 2021-2031
• 16 Cross AJ, Robbins EC, Pack K. et al. Long-term colorectal cancer incidence after adenoma removal and the effects of surveillance on incidence: a multicentre, retrospective, cohort study. Gut 2020; 69: 1645-1658
• 17 Lieberman D, Sullivan BA, Hauser ER. et al. Baseline colonoscopy findings associated with 10-year outcomes in a screening cohort undergoing colonoscopy surveillance. Gastroenterology 2020; 158: 862-874.e868
• 18 Lee JK, Jensen CD, Levin TR. et al. Long-term risk of colorectal cancer and related death after adenoma removal in a large, community-based population. Gastroenterology 2020; 158: 884-894.e885
• 19 Jover R, Bretthauer M, Dekker E. et al. Rationale and design of the European Polyp Surveillance (EPoS) trials. Endoscopy 2016; 48: 571-578
• 20 Njor SH, Friis-Hansen L, Andersen B. et al. Three years of colorectal cancer screening in Denmark. Cancer Epidemiol 2018; 57: 39-44
• 21 Schmidt M, Schmidt SAJ, Adelborg K. et al. The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol 2019; 11: 563-591
• 22 Thomsen MK, Njor SH, Rasmussen M. et al. Validity of data in the Danish Colorectal Cancer Screening Database. Clin Epidemiol 2017; 9: 105-111
• 23 Ingeholm P, Gögenur I, Iversen LH. Danish Colorectal Cancer Group Database. Clin Epidemiol 2016; 8: 465-468
• 24 Bjerregaard B, Larsen OB. The Danish Pathology Register. Scand J Public Health 2011; 39: 72-74
• 25 Dekker E, Bleijenberg A, Balaguer F. et al. Update on the World Health Organization criteria for diagnosis of serrated polyposis syndrome. Gastroenterology 2020; 158: 1520-1523
• 26 Pedersen L, Valori R, Bernstein I. et al. Risk of post-colonoscopy colorectal cancer in Denmark: time trends and comparison with Sweden and the English National Health Service. Endoscopy 2019; 51: 733-741
• 27 Zhang Y, Wang X, Zhang W. et al. Incidence of colorectal cancer at different screening intervals after index colonoscopy and post-polypectomy: a meta-analysis of 811,181 participants. Expert Rev Gastroenterol Hepatol 2022; 16: 1101-1114
• 28 Troelsen FS, Sørensen HT, Pedersen L. et al. Root-cause analysis of 762 Danish post-colonoscopy colorectal cancer patients. Clin Gastroenterol Hepatol 2023; 21: 3160-3169.e5
• 29 Lund M, Trads M, Njor SH. et al. Quality indicators for screening colonoscopy and colonoscopist performance and the subsequent risk of interval colorectal cancer: a systematic review. JBI Database System Rev Implement Rep 2019; 17: 2265-2300
• 30 Wisse PHA, Erler NS, de Boer SY. et al. Adenoma detection rate and risk for interval postcolonoscopy colorectal cancer in fecal immunochemical test-based screening: a population-based cohort study. Ann Intern Med 2022; 175: 1366-1373
• 31 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397
• 32 Bjerrum A, Lindebjerg J, Andersen O. et al. Long-term risk of colorectal cancer after screen-detected adenoma: experiences from a Danish gFOBT-positive screening cohort. Int J Cancer 2020; 147: 940-947
• 33 Djinbachian R, Dubé A-J, Durand M. et al. Adherence to post-polypectomy surveillance guidelines: a systematic review and meta-analysis. Endoscopy 2019; 51: 673-683
• 34 Bülow Therkildsen S, Larsen PT, Njor S. Subsequent participation in organized FIT based screening following screen-derived colonoscopy – a Danish nationwide cohort study. Prev Med Rep 2023; 32: 102125