Time from Positive Screening Fecal Occult Blood Test to Colonoscopy and Risk of Neoplasia

  • Ziad F. GelladEmail author
  • Daniel Almirall
  • Dawn Provenzale
  • Deborah A. Fisher
Original Article


There is no guideline defining the optimal time from a positive screening fecal occult blood test to follow-up colonoscopy. We reviewed records of 231 consecutive primary care patients who received a colonoscopy within 18 months of a positive fecal occult blood test. We examined the relationship between time to colonoscopy and risk of neoplasia on colonoscopy using a logistic regression analysis adjusting for potential confounders such as age, race, and gender. The mean time to colonoscopy was 236 days. Longer time to colonoscopy (OR = 1.10, P = 0.01) and older age (OR 1.04, P = 0.01) were associated with higher odds of neoplasia. The association of time with advanced neoplasia was positive, but not statistically significant (OR 1.07, P = 0.14). In this study, a longer interval to colonoscopy after fecal occult blood test was associated with an increased risk of neoplasia. Determining the optimal interval for follow-up is desirable and will require larger studies.


Colonic neoplasm Occult blood Colonoscopy Follow-up studies 



This study was funded in part by NIH T32 DK007568-17 (Dr Gellad). Dr. Fisher was supported by a VA HSR&D Career Development Award (CDA03-174). Dr. Provenzale was supported by an NIH K24 (DK002926-07). The authors have no relevant conflicts of interest to disclose.


  1. 1.
    Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–1477. doi: 10.1016/S0140-6736(96)03386-7.CrossRefPubMedGoogle Scholar
  2. 2.
    Kronborg O, Fenger C, Jorn O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–1471. doi: 10.1016/S0140-6736(96)03430-7.CrossRefPubMedGoogle Scholar
  3. 3.
    Mandel JS, Bond JH, Church TR. Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med. 1993;328:1365–1371. doi: 10.1056/NEJM199305133281901.CrossRefPubMedGoogle Scholar
  4. 4.
    Towler B, Irwig L, Glasziou P, Kewenter J, Weller D, Silagy C. A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, Hemoccult. BMJ. 1998;317:559–565.PubMedGoogle Scholar
  5. 5.
    Bond JH. The place of fecal occult blood test in colorectal cancer screening in 2006: the US perspective. Am J Gastroenterol. 2006;101:219–221. doi: 10.1111/j.1572-0241.2006.00486.x.CrossRefPubMedGoogle Scholar
  6. 6.
    Ramsey SD, Mandelson MT, Berry K, Etzioni R, Harrison R. Cancer-attributable costs of diagnosis and care for persons with screen-detected versus symptom-detected colorectal cancer. Gastroenterology. 2003;125:1645–1650. doi: 10.1053/j.gastro.2003.09.032.CrossRefPubMedGoogle Scholar
  7. 7.
    Winawer S, Fletcher R, Rex DK, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology. 2003;124:544–560. doi: 10.1053/gast.2003.50044.CrossRefPubMedGoogle Scholar
  8. 8.
    Fisher DA, Jeffreys A, Coffman CJ, Fasanella K. Barriers to full colon evaluation for a positive fecal occult blood test. Cancer Epidemiol Biomarkers Prev. 2006;15:1232–1235. doi: 10.1158/1055-9965.EPI-05-0916.CrossRefPubMedGoogle Scholar
  9. 9.
    Daigh JD. Healthcare Inspection: Colorectal Cancer Detection and Management in Veterans Health Administration Facilities. Washington, DC: VA Office of Inspector General; 2006.Google Scholar
  10. 10.
    US Department of Veterans Affairs. VHA directive 2007–004 Colorectal Cancer Screening, January 12, 2007. Available at Accessed 3 December 2008.
  11. 11.
    Fernandez E, Porta M, Malats N, Belloc J, Gallen M. Symptom-to-diagnosis interval and survival in cancers of the digestive tract. Dig Dis Sci. 2002;47:2434–2440. doi: 10.1023/A:1020535304670.CrossRefPubMedGoogle Scholar
  12. 12.
    Rupassara KS, Ponnusamy S, Withanage N, Milewski PJ. A paradox explained? Patients with delayed diagnosis of symptomatic colorectal cancer have good prognosis. Colorectal Dis. 2006;8:423–429. doi: 10.1111/j.1463-1318.2006.00958.x.CrossRefPubMedGoogle Scholar
  13. 13.
    Porta M, Gallen M, Malats N, Planas J. Influence of “diagnostic delay” upon cancer survival: an analysis of five tumour sites. J Epidemiol Community Health. 1991;45:225–230.CrossRefPubMedGoogle Scholar
  14. 14.
    Lieberman D, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med. 2000;343:162–168. doi: 10.1056/NEJM200007203430301.CrossRefPubMedGoogle Scholar
  15. 15.
    Lieberman D, Prindiville S, Weiss DG, Willett W. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA. 2003;290:2959–2967. doi: 10.1001/jama.290.22.2959.CrossRefPubMedGoogle Scholar
  16. 16.
    Jobson JD. Applied Multivariate Data Analysis. New York: Springer; 1992.Google Scholar
  17. 17.
    Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: Wiley & Sons, Inc.; 1989.Google Scholar
  18. 18.
    van der Vaart AW. Asymptotic Statistics. Cambridge, MA: Cambridge University Press; 1998.Google Scholar
  19. 19.
    Eddy DM. Screening for colorectal cancer. Ann Intern Med. 1990;113:373–384.PubMedGoogle Scholar
  20. 20.
    Almendingen K, Hofstad B, Vatn MH. Does high body fatness increase the risk of presence and growth of colorectal adenomas followed up in situ for 3 years? Am J Gastroenterol. 2001;96:2238–2246. doi: 10.1111/j.1572-0241.2001.03942.x.CrossRefPubMedGoogle Scholar
  21. 21.
    Moghaddam AA, Woodward M, Huxley R. Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events. Cancer Epidemiol Biomarkers Prev. 2007;16:2533–2547. doi: 10.1158/1055-9965.EPI-07-0708.CrossRefPubMedGoogle Scholar
  22. 22.
    Jass JR, Whitehall VLJ, Young J, Leggett BA. Emerging concepts in colorectal neoplasia. Gastroenterology. 2002;123:862–876. doi: 10.1053/gast.2002.35392.CrossRefPubMedGoogle Scholar
  23. 23.
    Jass JR. Molecular heterogeneity of colorectal cancer: implications for cancer control. Surg Oncol. 2007;16:S7–S9. doi: 10.1016/j.suronc.2007.10.039.CrossRefPubMedGoogle Scholar
  24. 24.
    Lieberman D, Weiss DG. One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med. 2001;345:555–560. doi: 10.1056/NEJMoa010328.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Ziad F. Gellad
    • 1
    • 2
    Email author
  • Daniel Almirall
    • 1
    • 3
  • Dawn Provenzale
    • 1
    • 2
  • Deborah A. Fisher
    • 1
    • 2
  1. 1.Center for Health Services Research in Primary CareDurham Veterans Affairs Medical CenterDurhamUSA
  2. 2.Department of Medicine, Division of GastroenterologyDuke University Medical CenterDurhamUSA
  3. 3.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamUSA

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