Long-term follow-up reduces CRC risk after FOBT reveals high-risk adenoma

  • Bjerrum A & al.
  • Int J Cancer
  • 2 Jan 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Follow-up of high-risk adenomas detected after a fecal occult blood test (FOBT) reduces colorectal cancer (CRC) risk to that of the general population.

Why this matters

  • The study is the first to assess long-term CRC incidence in individuals diagnosed with adenoma after FOBT.

Study design

  • Population-based cohort study in 2 Danish counties (2005-2006); n=80,563; reference population, n=1,240,348.
  • Funding: None disclosed.

Key results

  • 1924 (2.4%) had positive FOBT, of whom 37% were found to have adenomas.
  • Based on European guidelines for quality assurance in CRC screening and diagnosis, 47% of adenoma patients were in the intermediate-risk group, 23% low risk, and 30% high risk.
  • CRC incidence:
    • Patients with adenoma: 322 (95% CI, 212-489) cases per 100,000 person-years.
    • Reference population: 244 (95% CI, 242-247) cases per 100,000 person-years.
  • High-risk adenomas found after a positive FOBT were associated with higher CRC risk than the reference population (aHR, 1.80; 95% CI, 1.00-3.26).
  • High-risk adenomas with no follow-up were associated with a higher CRC risk compared with the reference population (aHR, 3.34; 95% CI, 1.67-6.69).
  • Patients with high-risk adenoma who underwent follow-up colonoscopy had a similar risk to the reference population.

Limitations

  • Nonrandomized.