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Prompt colonoscopy required after positive bowel cancer tests

Thu, 03/12/2020 - 10:30
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A prompt colonoscopy should be provided to all patients with positive faecal immunochemical test (FIT) results, regardless of whether the test was offered through the National Bowel Cancer Screening Program or via a community-based source, according to research published by the Medical Journal of Australia.

The study, ‘Comparison of colonic neoplasia detection rates in patients screened inside and outside the National Bowel Cancer Screening Program’, led by Dr Simon Whitcher, a surgical registrar at John Hunter Hospital, working with academics from the University of Newcastle, analysed data from the Newcastle Direct Access Colonoscopy Service (DACS) for the period 2014–18 to investigate whether colonoscopy services should provide endoscopies to patients with positive FIT results with the same priority, regardless of whether the test was instigated by the NBCSP.

The researchers analysed 2,365 complete screening colonoscopy outcomes – 1,233 following community-initiated and 1,132 following NBCSP testing. They reported that the colonoscopy quality was high: the completion rate was 97.1% (community‐initiated, 1193 of 1233, 96.8%; NBCSP, 1104 of 1132, 97.5%), and the adenoma detection rate was 49%, exceeding international benchmarks for either symptomatic or screening patients (for screening: at least 25% in men and 15% in women;6 for populations enriched with patients with positive FIT results: 35%7).

They reported that the rate of colorectal neoplasia (malignant or pre‐malignant) was similar in the two groups. However, the difference in the rates of adenocarcinoma was not statistically significant (p=0.09). The only statistically significant difference by type was that the incidence of high risk adenoma was slightly higher in the NBCSP group (22.9% v 17.2%, p<0.001).

“We found that the incidence and detection rates of colorectal neoplasia in people aged 50–74 years were similar for people with positive results for NBCSP or community‐initiated FITs,” the authors concluded. “The large population in our study means that it provides colonoscopy providers strong evidence that evaluation should be performed equally promptly for patients with positive results from NBSCP and community‐initiated FITs.”

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