Association between time to colonoscopy after positive fecal testing and colorectal cancer outcomes: A systematic review
Date
2020Author
Forbes, Nauzer
Hilsden, Robert J.
Martel, Myriam
Ruan, Yibing
Dube, Catherine
Rostom, Alaa
Shorr, Risa
Menard, Charles
Brenner, Darren R.
Barkun, Alan N.
Heitman, Steven J.
Metadata
Show full item recordAbstract
Colonoscopy is required following a positive fecal screening test for colorectal
cancer (CRC). It remains unclear to what extent time to colonoscopy is associated with CRC-related outcomes. We performed a systematic review to elucidate this relationship.
Methods
An electronic search was performed through April 2020 for studies reporting
associations between time from positive fecal testing to colonoscopy and outcomes
including CRC incidence (primary outcome), CRC stage at diagnosis, and/or CRC-specific
mortality. Our primary objective was to quantify these relationships following positive
fecal immunochemical testing (FIT). Two authors independently performed screening,
abstraction, and risk of bias assessments.
Results
From 1,612 initial studies, 8 were included in the systematic review, with 5
reporting outcomes for FIT. Although meta-analysis was not possible, consistent trends
between longer time delays and worse outcomes were apparent in all studies. Colonoscopy
performed beyond 9 months from positive FIT compared to within 1 month was
significantly associated with a higher incidence of CRC, with adjusted odds ratios (AORs) of
1.75 and 1.48 in the two largest studies. These studies also reported significant
associations between colonoscopy performed beyond 9 months and higher incidence of
Journal Pre-proof
advanced stage CRC (stage III or IV) at diagnosis, with AORs of 2.79 and 1.55, respectively.
Conclusions
Colonoscopy for positive FIT should not be delayed beyond 9 months. Given the
additional time required for urgent referrals and surgical planning for CRC, colonoscopy
should ideally be performed well in advance of 9 months following a positive FIT.
Palabras clave
Colorectal neoplasms; Mass screening; ColonoscopyLink to resource
https://doi.org/10.1016/j.cgh.2020.09.048Collections
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