Stop Guaiac Testing for 5 Years After Negative Colonoscopy

For those still using guaiac-based FOBT, data clearly support this recommendation.

Some guidelines recommend that fecal occult blood testing (FOBT) be discontinued for 5 years after a negative colonoscopy, but in clinical practice, primary care providers frequently still perform it during that interval.

In the current single-center study, researchers assessed rates of advanced neoplasms and cancers in 1119 patients with positive guaiac test results from home or digital rectal testing stratified by previous colonoscopy experience (never, >10 years previously, 5–10 years previously, or <5 years previously). Participants were identified between 1997 and 2005 and were aged ≥50 years, asymptomatic, and at average risk for colorectal cancer.

The incidence of advanced neoplasms in the four groups was 30%, 27%, 10%, and 1%, respectively. The incidence of cancer was 11%, 8%, 5%, and 0%, respectively.

Comment

I first saw this brilliantly pragmatic study in abstract form many years ago and have long anticipated its publication. I have cited the abstract results many times in presentations and suspected that the delay in publication stemmed from the untimely death of the great Edmund Bini, whose contribution is graciously acknowledged by the authors. Unfortunately, we do not know the fraction of tests obtained by digital rectal examination, a format now deemed inappropriate. Furthermore, all guidelines have recommended replacement of guaiac testing with fecal immunochemical testing (FIT), and some studies have found that FIT maintains its positive-predictive value even shortly after a negative colonoscopy. Ultimately, the need for FIT after negative colonoscopy should be linked to the adenoma detection rate of the colonoscopist. What the primary care physician most needs to know in deciding whether to continue FIT after a negative colonoscopy is the individual adenoma detection rates of their patients' colonoscopists.

Reviewing Author

Douglas K. Rex, MD

Disclosures

Consultant/Advisory BoardOlympus Corporation America; Boston Scientific

Speaker’s BureauOlympus

Grant/Research SupportMedtronic; Boston Scientific; Colonary Solutions; Paion Medical; Medivators; Braintree Laboratories

Editorial BoardsWorld Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology; GI Journal Watch; Austin Journal of Gastroenterology; World Journal of Gastrointestinal Pharmacology & Therapeutics

Leadership Positions in Professional SocietiesAmerican Society for Gastrointestinal Endoscopy (Treasurer); US Multi-Society Task Force (AGA, ACG, ASGE) (Chair)