Colorectal cancer incidence following a negative colonoscopy in fecal immunochemical test-based screening: a nationwide cohort study after 8 years of screening in Denmark

Pernille T. Larsen; Susanne F. Jørgensen; Morten Rasmussen; Berit Andersen; Amanda J. Cross; Sisse H. Njor

doi:10.1055/a-2551-1471

Endoscopy, Table of Contents

Endoscopy 2025; 57(08): 864-873
DOI: 10.1055/a-2551-1471

Original article

Colorectal cancer incidence following a negative colonoscopy in fecal immunochemical test-based screening: a nationwide cohort study after 8 years of screening in Denmark

Pernille T. Larsen

¹University Research Clinic for Cancer screening, Randers Regional Hospital, Randers, Denmark

²Department of Clinical Medicine, Aarhus University Faculty of Health Sciences, Aarhus, Denmark

³Research Unit for Screening and Epidemiology, Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark

,

Susanne F. Jørgensen

³Research Unit for Screening and Epidemiology, Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark

⁴Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark

⁵Danish Colorectal Cancer Center South, Lillebaelt Hospital – University Hospital of Southern Denmark, Vejle, Denmark

,

Morten Rasmussen

⁶Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark (Ringgold ID: RIN53166)

⁷Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

,

Berit Andersen

¹University Research Clinic for Cancer screening, Randers Regional Hospital, Randers, Denmark

²Department of Clinical Medicine, Aarhus University Faculty of Health Sciences, Aarhus, Denmark

,

Amanda J. Cross

⁸Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland

⁹Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland

,

Sisse H. Njor

²Department of Clinical Medicine, Aarhus University Faculty of Health Sciences, Aarhus, Denmark

³Research Unit for Screening and Epidemiology, Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark

⁴Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark

⁵Danish Colorectal Cancer Center South, Lillebaelt Hospital – University Hospital of Southern Denmark, Vejle, Denmark

› Author Affiliations

Abstract

Background

Screening participants with a positive fecal immunochemical test (FIT) result and a subsequent negative colonoscopy are quarantined from the Danish bowel cancer screening program for 8 years. This recommendation is based on evidence from settings other than FIT-based screening, but referral of this evidence is not necessarily sufficient. We estimated the colorectal cancer (CRC) risk among these FIT-positive/colonoscopy-negative individuals and compared it with the risk in a historical unscreened population.

Methods

Using national health registers in Denmark, we compared 29 936 participants with a positive FIT but negative colonoscopy with 720 850 randomly selected unscreened controls born 9 years earlier (ratio 1:24). Controls were assigned a pseudo-colonoscopy date 9 years prior to the negative colonoscopy group. We examined cases per 10 000 person-years and estimated relative risks (RR) and 95%CIs for CRC.

Results

After 8 years’ follow-up, CRC risk was lower among FIT-positive/colonoscopy-negative participants compared with controls (RR 0.72, 95%CI 0.61–0.84). By age group and sex, the lower risk was only evident for women and men in their 60s (RR 0.67 [95%CI 0.47–0.96] and RR 0.65 [95%CI 0.48–0.88], respectively) and men in their 70s (RR 0.60 [95%CI 0.44–0.84]).

Conclusion

The overall risk for CRC was lower for individuals with a positive FIT but negative colonoscopy compared with unscreened controls. However, the lower risk might not justify 8 years of quarantine, especially for women and younger age groups. Individualized screening is warranted and transfer of evidence from non-FIT screening should be done carefully.

Full Text

References

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Supplementary Material

Supplementary Material