General screening program. Fecal occult blood test is done first, and those who are positive will then undergo colonoscopy to rule out benign and malignant tumors of the large intestine. How long is it appropriate to do colonoscopy after finding positive fecal occult blood?
I. Colorectal cancer (colorectal cancer) screening
About 1.2 million people worldwide are diagnosed with colorectal cancer every year, and the median age of incidence is about 70 years old.
The secondary prevention view of colorectal cancer is early detection and early resection. Early detection of colorectal cancer allows for surgical radical treatment. This is what colorectal cancer screening is all about.
Colorectal cancer screening has to balance the effectiveness and benefit of the screening program. Annual or bi-annual fecal occult blood testing and colonoscopy every five years are recommended for ages over 50 years. One study showed that annual fecal occult blood screening reduced colorectal cancer mortality by 16 percent
of colorectal cancer mortality. If a first-degree relative has a history of colorectal cancer, screening needs to be advanced to age 40 or earlier, and a rigorous screening program can be developed by contacting a physician.
Colonoscopy is mandatory for those with positive fecal occult blood. If colonoscopy reveals adenomas, hyperplastic polyps larger than 1 cm, or colorectal cancer, they must be surgically removed.
But in reality, even if a fecal occult blood test is positive, people tend to delay it for some time because of fear, ignorance, indifference, or the chores of life and work or health insurance. There is no urgency or a considerable period of time before going or not going for colonoscopy. So just how long is the appropriate interval for a colonoscopy after a positive fecal occult blood test?
II. Recommendations from two clinical studies
Third, how soon is as soon as possible
After a positive fecal occult blood test, how long is the interval between colonoscopies? There is no clear time requirement. Most clinical guidelines recommend: as soon as possible. But how soon is “as soon as possible”? Let’s take a look at two clinical studies to see how soon is “as soon as possible.
A study at Southwestern Medical Center retrospectively analyzed 1,267 cases of positive fecal occult blood from 2010 to 2013, with 536 cases (42.3%)
536 (42.3%) had not undergone a colonoscopy within 1 year of the positive fecal occult blood finding. Of these, 307 cases (57%) were due to personal factors, 97 cases
(18%) were due to physician or medical group factors, and 118 (22%) were due to health insurance or other systemic factors.
Another study involving 71,439 patients aged 50 to 75 years with positive fecal occult blood suggested that colonoscopy should be performed within about 6 months of a positive fecal occult blood test, while older adults should have a colonoscopy 3 months after a positive test.
Our experience is “as soon as possible”: colonoscopy should be done preferably within 6 months after a positive fecal occult blood test, and colonoscopy should be done 3 months after a positive test in elderly people or people with a family history of the disease who are at high risk.
The main reason for this recommendation is to consider that once a positive fecal occult blood is found, it suggests the presence of lesions in the colorectum that potentially lead to bleeding, and if delayed too long, otherwise benign polyps may become malignant. Therefore, it is best to undergo colonoscopy as early as possible! But it’s not as urgent as having a colonoscopy every other day!