Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality

Analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program

Sherry Yueh Hsia Chiu, Shu Ling Chuang, Sam Li Sheng Chen, Amy Ming Fang Yen, Jean Ching Yuan Fann, Dun Cheng Chang, Yi Chia Lee, Ming Shiang Wu, Chu Kuang Chou, Wen Feng Hsu, Shu Ti Chiou, Han Mo Chiu

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19 Citations (Scopus)

Abstract

Objectives Interval colorectal cancer (CRC) after colonoscopy may affect effectiveness and cost-effectiveness of screening programmes. We aimed to investigate whether and how faecal haemoglobin concentration (FHbC) of faecal immunochemical testing (FIT) affected the risk prediction of interval cancer (IC) caused by inadequate colonoscopy quality in a FIT-based population screening programme. Design From 2004 to 2009, 29 969 subjects underwent complete colonoscopy after positive FIT in the Taiwanese Nationwide CRC Screening Program. The IC rate was traced until the end of 2012. The incidence of IC was calculated in relation to patient characteristics, endoscopy-related factors (such adenoma detection rate (ADR)) and FHbC. Poisson regression analysis was performed to assess the potential risk factors for colonoscopy IC. Results One hundred and sixty-two ICs developed after an index colonoscopy and the estimated incidence was 1.14 per 1000 person-years of observation for the entire cohort. Increased risk of IC was most remarkable in the uptake of colonoscopy in settings with ADR lower than 15% (adjusted relative risk (aRR)=3.09, 95% CI 1.55 to 6.18) and then higher FHbC (μg Hb/g faeces) (100-149: aRR=2.55, 95% CI 1.52 to 4.29, ≥150: aRR=2.74, 95% CI 1.84 to 4.09) with adjustment for older age and colorectal neoplasm detected at baseline colonoscopy. Similar findings were observed for subjects with negative index colonoscopy. Conclusions Colonoscopy ICs arising from FIT-based population screening programmes were mainly influenced by inadequate colonoscopy quality and independently predicted by FHbC that is associated with a priori chance of advanced neoplasm. This finding is helpful for future modification of screening logistics based on FHbC.

Original languageEnglish
JournalGut
DOIs
Publication statusPublished - Feb 1 2017

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Colonoscopy
Early Detection of Cancer
Colorectal Neoplasms
Hemoglobins
Neoplasms
Population Control
Adenoma
Incidence
Feces
Endoscopy
Cost-Benefit Analysis
Regression Analysis
Observation

ASJC Scopus subject areas

  • Gastroenterology

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Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality : Analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program. / Chiu, Sherry Yueh Hsia; Chuang, Shu Ling; Chen, Sam Li Sheng; Yen, Amy Ming Fang; Fann, Jean Ching Yuan; Chang, Dun Cheng; Lee, Yi Chia; Wu, Ming Shiang; Chou, Chu Kuang; Hsu, Wen Feng; Chiou, Shu Ti; Chiu, Han Mo.

In: Gut, 01.02.2017.

Research output: Contribution to journalArticle

Chiu, Sherry Yueh Hsia ; Chuang, Shu Ling ; Chen, Sam Li Sheng ; Yen, Amy Ming Fang ; Fann, Jean Ching Yuan ; Chang, Dun Cheng ; Lee, Yi Chia ; Wu, Ming Shiang ; Chou, Chu Kuang ; Hsu, Wen Feng ; Chiou, Shu Ti ; Chiu, Han Mo. / Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality : Analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program. In: Gut. 2017.
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abstract = "Objectives Interval colorectal cancer (CRC) after colonoscopy may affect effectiveness and cost-effectiveness of screening programmes. We aimed to investigate whether and how faecal haemoglobin concentration (FHbC) of faecal immunochemical testing (FIT) affected the risk prediction of interval cancer (IC) caused by inadequate colonoscopy quality in a FIT-based population screening programme. Design From 2004 to 2009, 29 969 subjects underwent complete colonoscopy after positive FIT in the Taiwanese Nationwide CRC Screening Program. The IC rate was traced until the end of 2012. The incidence of IC was calculated in relation to patient characteristics, endoscopy-related factors (such adenoma detection rate (ADR)) and FHbC. Poisson regression analysis was performed to assess the potential risk factors for colonoscopy IC. Results One hundred and sixty-two ICs developed after an index colonoscopy and the estimated incidence was 1.14 per 1000 person-years of observation for the entire cohort. Increased risk of IC was most remarkable in the uptake of colonoscopy in settings with ADR lower than 15{\%} (adjusted relative risk (aRR)=3.09, 95{\%} CI 1.55 to 6.18) and then higher FHbC (μg Hb/g faeces) (100-149: aRR=2.55, 95{\%} CI 1.52 to 4.29, ≥150: aRR=2.74, 95{\%} CI 1.84 to 4.09) with adjustment for older age and colorectal neoplasm detected at baseline colonoscopy. Similar findings were observed for subjects with negative index colonoscopy. Conclusions Colonoscopy ICs arising from FIT-based population screening programmes were mainly influenced by inadequate colonoscopy quality and independently predicted by FHbC that is associated with a priori chance of advanced neoplasm. This finding is helpful for future modification of screening logistics based on FHbC.",
author = "Chiu, {Sherry Yueh Hsia} and Chuang, {Shu Ling} and Chen, {Sam Li Sheng} and Yen, {Amy Ming Fang} and Fann, {Jean Ching Yuan} and Chang, {Dun Cheng} and Lee, {Yi Chia} and Wu, {Ming Shiang} and Chou, {Chu Kuang} and Hsu, {Wen Feng} and Chiou, {Shu Ti} and Chiu, {Han Mo}",
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T1 - Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality

T2 - Analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program

AU - Chiu, Sherry Yueh Hsia

AU - Chuang, Shu Ling

AU - Chen, Sam Li Sheng

AU - Yen, Amy Ming Fang

AU - Fann, Jean Ching Yuan

AU - Chang, Dun Cheng

AU - Lee, Yi Chia

AU - Wu, Ming Shiang

AU - Chou, Chu Kuang

AU - Hsu, Wen Feng

AU - Chiou, Shu Ti

AU - Chiu, Han Mo

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Objectives Interval colorectal cancer (CRC) after colonoscopy may affect effectiveness and cost-effectiveness of screening programmes. We aimed to investigate whether and how faecal haemoglobin concentration (FHbC) of faecal immunochemical testing (FIT) affected the risk prediction of interval cancer (IC) caused by inadequate colonoscopy quality in a FIT-based population screening programme. Design From 2004 to 2009, 29 969 subjects underwent complete colonoscopy after positive FIT in the Taiwanese Nationwide CRC Screening Program. The IC rate was traced until the end of 2012. The incidence of IC was calculated in relation to patient characteristics, endoscopy-related factors (such adenoma detection rate (ADR)) and FHbC. Poisson regression analysis was performed to assess the potential risk factors for colonoscopy IC. Results One hundred and sixty-two ICs developed after an index colonoscopy and the estimated incidence was 1.14 per 1000 person-years of observation for the entire cohort. Increased risk of IC was most remarkable in the uptake of colonoscopy in settings with ADR lower than 15% (adjusted relative risk (aRR)=3.09, 95% CI 1.55 to 6.18) and then higher FHbC (μg Hb/g faeces) (100-149: aRR=2.55, 95% CI 1.52 to 4.29, ≥150: aRR=2.74, 95% CI 1.84 to 4.09) with adjustment for older age and colorectal neoplasm detected at baseline colonoscopy. Similar findings were observed for subjects with negative index colonoscopy. Conclusions Colonoscopy ICs arising from FIT-based population screening programmes were mainly influenced by inadequate colonoscopy quality and independently predicted by FHbC that is associated with a priori chance of advanced neoplasm. This finding is helpful for future modification of screening logistics based on FHbC.

AB - Objectives Interval colorectal cancer (CRC) after colonoscopy may affect effectiveness and cost-effectiveness of screening programmes. We aimed to investigate whether and how faecal haemoglobin concentration (FHbC) of faecal immunochemical testing (FIT) affected the risk prediction of interval cancer (IC) caused by inadequate colonoscopy quality in a FIT-based population screening programme. Design From 2004 to 2009, 29 969 subjects underwent complete colonoscopy after positive FIT in the Taiwanese Nationwide CRC Screening Program. The IC rate was traced until the end of 2012. The incidence of IC was calculated in relation to patient characteristics, endoscopy-related factors (such adenoma detection rate (ADR)) and FHbC. Poisson regression analysis was performed to assess the potential risk factors for colonoscopy IC. Results One hundred and sixty-two ICs developed after an index colonoscopy and the estimated incidence was 1.14 per 1000 person-years of observation for the entire cohort. Increased risk of IC was most remarkable in the uptake of colonoscopy in settings with ADR lower than 15% (adjusted relative risk (aRR)=3.09, 95% CI 1.55 to 6.18) and then higher FHbC (μg Hb/g faeces) (100-149: aRR=2.55, 95% CI 1.52 to 4.29, ≥150: aRR=2.74, 95% CI 1.84 to 4.09) with adjustment for older age and colorectal neoplasm detected at baseline colonoscopy. Similar findings were observed for subjects with negative index colonoscopy. Conclusions Colonoscopy ICs arising from FIT-based population screening programmes were mainly influenced by inadequate colonoscopy quality and independently predicted by FHbC that is associated with a priori chance of advanced neoplasm. This finding is helpful for future modification of screening logistics based on FHbC.

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