Yield of repeat colonoscopy in asymptomatic individuals with a positive fecal immunochemical test and recent colonoscopy

A fecal immunochemical test (FIT) is often repeated annually, even after a recent colonoscopy. However, there are no published data on the proper approach to FIT-positive patients after a recent colonoscopy. We compared colorectal cancer (CRC) and advanced colorectal neoplasia (ACRN) prevalence based on the interval since the last colonoscopy. We reviewed asymptomatic screenees aged ≥50 years who underwent FIT and colonoscopy. Of 2228 FIT-positive participants, 514 had a colonoscopy less than 3 years before (group 1), 427 had a colonoscopy had a colonoscopy 3 to 10 years before (group 2), and 1287 had a colonoscopy >10 years before or no colonoscopy (group 3). The prevalence of CRC in groups 1, 2, and 3 was 2.1%, 1.6%, and 7.2%, respectively, and that for ACRN was 10.9%, 12.6%, and 26.0%, respectively. Even after adjusting for confounders, CRC and ACRN detection rates in group 1 were lower than those in group 3 but not lower than those in group 2. Among 6135 FIT-negative participants, the prevalence of CRC in the 3 groups was .7%, .4%, and 3.4%, respectively, and that for ACRN was 6.0%, 6.1%, and 14.7%, respectively. CRC and ACRN detection rates were significantly higher in FIT-positive participants than in FIT-negative participants in all 3 groups. In FIT-positive patients who underwent colonoscopy within the prior 3 years, CRC and ACRN prevalence was not low. Our findings support the U.S. Multi-Society Task Force on the CRC screening recommendation that repeat colonoscopy be offered to patients with positive FIT results and recent colonoscopy.