Multiple Negative FITs Signal Lower Risk of Advanced Neoplasia

Multiple rounds of negative fecal immunochemical tests can signal which patients under colonoscopy-based surveillance are less likely to develop advanced neoplasia, according to study results published in Clinical Gastroenterology and Hepatology.

“This evidence supports integration of fecal immunochemical testing with colonoscopy into surveillance programs for those at above-average risk for colorectal cancer,” wrote corresponding author Molla Mesele Wassie, PhD, of Flinders University in Australia, and coauthors. “Therefore, besides adenoma detection rate, the number of negative interval fecal immunochemical test results could be considered when recommending colonoscopy surveillance intervals.”

The retrospective cohort study included 3369 people, ages 50 through 74, who were at increased risk of neoplasia and had enrolled in a program that provides surveillance colonoscopy at recommended intervals and fecal immunochemical testing between colonoscopies. Participants completed up to 4 rounds of fecal immunochemical testing, at intervals of 1 to 2 years, with negative results. The occurrence of advanced neoplasia — colorectal cancer or advanced adenoma — was determined at the follow-up colonoscopy.

After multiple rounds of negative fecal immunochemical tests, a person’s risk of advanced neoplasia was low, according to the study. Overall, the cohort had a 9.9% incidence of advanced neoplasia, which decreased with more rounds of negative tests. After a single negative fecal immunochemical test, the incidence of advanced neoplasia was 11.1%; after 4 negative tests, the incidence was 5.7%.

Compared with just 1 negative test, 3 and 4 rounds of negative fecal immunochemical tests were each associated with a significantly lower risk of advanced neoplasia, the study found.

“Implementing this in practice by extending colonoscopy intervals would lessen demands on colonoscopy when resources are constrained by health care funding or events such as the pandemic,” researchers wrote.

—Jolynn Tumolo

Reference:
Wassie MM, Young GP, Winter JM, et al. Multiple negative faecal immunochemical tests reduce risk of advanced neoplasia in a colonoscopy surveillance program. Clin Gastroenterol Hepatol. Published online January 4, 2023. https://doi.org/10.1016/j.cgh.2022.12.024