Does a long time to colonoscopy after a positive fecal immunochemical test result have a deleterious impact on colorectal cancer outcomes?
Grancher A et al, Gut. 2026;75(4):748-759
The risk of colorectal carcinoma, advanced-stage colorectal carcinoma or advanced adenoma was not increased in patients who received a colonoscopy after 3–24 months compared to those with an early endoscopy after 2–3 months in a nationwide cohort study from France.
Background: Depending on the colorectal cancer (CRC) screening programme, a colonoscopy should be performed within 1–3 months after a positive faecal immunochemical test (FIT) result. However, such short timescales may be difficult to meet and seem trivial when most CRCs take years to develop.
Objective: To assess the impact of time to colonoscopy on CRC outcomes.
Design: This French nationwide retrospective cohort study included individuals with a positive FIT result between 2016 and 2019 and a subsequent colonoscopy performed within 24 months. The risks of CRC, advanced-stage CRC and advanced adenoma (AA) according to time interval to colonoscopy were assessed and evaluated on individual and socio-geographic characteristics.
Results: Overall, 374,113 FIT-positive individuals underwent post-FIT colonoscopy (86.6% compliance rate), with 21,616 CRCs and 122,359 AAs diagnosed. Compared with the 2–3 months interval class, no increased risk of CRC, advanced-stage CRC or AA was observed after 3 months up to 24 months, with adjusted odds ratio after 12 months at 0.93 (95% CI: 0.83–1.03), 1.04 (0.85–1.25) and 0.88 (0.82–0.93), respectively. Individuals with high faecal haemoglobin concentrations (f-Hb ≥ 200 µg/g) were respectively eight, eleven and two times more likely to have a CRC, an advanced-stage CRC or an AA as compared with the 30–40 µg/g class.
Conclusion: No increased risk of CRC, advanced-stage CRC or AA was observed up to 24 months. These findings suggest that ensuring colonoscopy compliance after a positive FIT may take precedence over rigid adherence to interval. The higher the f-Hb, the sooner the colonoscopy should be performed.