Table 2.
Time to colonoscopy after a positive FIT: sensitivity analyses
| Time to colonoscopya | Any CRC |
Advanced-stage CRCb |
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|---|---|---|---|---|---|---|---|---|---|---|
| Cases/Totalc | Rated | (95% CI) | Adj ORe |
(95% CI) | Cases/Totalc | Rated | (95% CI) | Adj ORe |
(95% CI) | |
| Reference group: 1–30 days | ||||||||||
| 1–30 days | 871 / 28,567 | 30 | ( 28, 32) | 1.00 | (reference) | 248 / 28,564 | 9 | ( 8, 10) | 1.00 | (reference) |
| 2 months | 685 / 24,644 | 28 | ( 26, 30) | 0.90 | (0.81, 0.99) | 173 / 24,642 | 7 | ( 6, 8) | 0.79 | (0.65, 0.97) |
| 3 months | 265 / 8,666 | 31 | ( 27, 34) | 0.93 | (0.80, 1.07) | 60 / 8,664 | 7 | ( 5, 9) | 0.73 | (0.54, 0.97) |
| 4–6 months | 165 / 5,251 | 31 | ( 27, 36) | 0.95 | (0.80, 1.13) | 46 / 5,249 | 9 | ( 6, 11) | 0.91 | (0.66, 1.25) |
| 7–9 months | 58 / 1,335 | 43 | ( 32, 54) | 1.27 | (0.96, 1.67) | 17 / 1,335 | 13 | ( 7, 19) | 1.22 | (0.74, 2.01) |
| 10–12 months | 37 / 748 | 49 | ( 34, 65) | 1.44 | (1.02, 2.02) | 14 / 747 | 19 | ( 9, 28) | 1.83 | (1.06, 3.17) |
| >12 months | 174 / 2,304 | 76 | ( 65, 86) | 2.19 | (1.84, 2.60) | 72 / 2,300 | 31 | (24, 38) | 2.99 | (2.27, 3.93) |
| |
|
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| Reference group: 8–60 days | ||||||||||
| |
|
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| 8–60 days | 1,492 / 51,820 | 29 | ( 27, 30) | 1.00 | (reference) | 392 / 51,815 | 8 | ( 7, 8) | 1.00 | (reference) |
| 3 months | 265 / 8,666 | 31 | ( 27, 34) | 0.99 | (0.87, 1.14) | 60 / 8,664 | 7 | ( 5, 9) | 0.84 | (0.64, 1.11) |
| 4–6 months | 165 / 5,251 | 31 | ( 27, 36) | 1.02 | (0.86, 1.20) | 46 / 5,249 | 9 | ( 6, 11) | 1.06 | (0.78, 1.44) |
| 7–9 months | 58 / 1,335 | 43 | ( 32, 54) | 1.36 | (1.04, 1.79) | 17 / 1,335 | 13 | ( 7, 19) | 1.43 | (0.87, 2.33) |
| 10–12 months | 37 / 748 | 49 | ( 34, 65) | 1.54 | (1.10, 2.16) | 14 / 747 | 19 | ( 9, 28) | 2.13 | (1.24, 3.67) |
| >12 months | 174 / 2,304 | 76 | ( 65, 86) | 2.34 | (1.98, 2.77) | 72 / 2,300 | 31 | (24, 38) | 3.48 | (2.68, 4.52) |
| |
|
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| Reference group: 8–90 days | ||||||||||
| |
|
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| 8–90 days | 1,757 / 60,486 | 29 | ( 28, 30) | 1.00 | (reference) | 452 / 60,479 | 7 | ( 7, 8) | 1.00 | (reference) |
| 4–6 months | 165 / 5,251 | 31 | ( 27, 36) | 1.02 | (0.87, 1.20) | 46 / 5,249 | 9 | ( 6, 11) | 1.09 | (0.80, 1.48) |
| 7–9 months | 58 / 1,335 | 43 | ( 32, 54) | 1.36 | (1.04, 1.79) | 17 / 1,335 | 13 | ( 7, 19) | 1.47 | (0.90, 2.40) |
| 10–12 months | 37 / 748 | 49 | ( 34, 65) | 1.54 | (1.10, 2.16) | 14 / 747 | 19 | ( 9, 28) | 2.19 | (1.28, 3.77) |
| >12 months | 174 / 2,304 | 76 | ( 65, 86) | 2.35 | (1.99, 2.77) | 72 / 2,300 | 31 | (24, 38) | 3.58 | (2.76, 4.63) |
| |
|
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| Excludes colonoscopies >24 months after FIT | ||||||||||
| |
|
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| 8–30 days | 807 / 27,176 | 30 | ( 28, 32) | 1.00 | (reference) | 219 / 27,173 | 8 | ( 7, 9) | 1.00 | (reference) |
| 2 months | 685 / 24,644 | 28 | ( 26, 30) | 0.92 | (0.82, 1.02) | 173 / 24,642 | 7 | ( 6, 8) | 0.85 | (0.69, 1.04) |
| 3 months | 265 / 8,666 | 31 | ( 27, 34) | 0.95 | (0.82, 1.10) | 60 / 8,664 | 7 | ( 5, 9) | 0.78 | (0.58, 1.04) |
| 4–6 months | 165 / 5,251 | 31 | ( 27, 36) | 0.98 | (0.82, 1.16) | 46 / 5,249 | 9 | ( 6, 11) | 0.98 | (0.70, 1.35) |
| 7–9 months | 58 / 1,335 | 43 | ( 32, 54) | 1.30 | (0.99, 1.71) | 17 / 1,335 | 13 | ( 7, 19) | 1.31 | (0.79, 2.16) |
| 10–12 months | 37 / 748 | 49 | ( 34, 65) | 1.47 | (1.04, 2.07) | 14 / 747 | 19 | ( 9, 28) | 1.97 | (1.14, 3.42) |
| >12 months | 105 / 1,521 | 69 | ( 56, 82) | 2.13 | (1.72, 2.64) | 42 / 1,520 | 28 | (19, 36) | 2.98 | (2.12, 4.18) |
| |
|
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| Includes <1 year membership before FIT, or prior endoscopy | ||||||||||
| |
|
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| 8–30 days | 999 / 33,924 | 29 | ( 28, 31) | 1.00 | (reference) | 283 / 33,920 | 8 | ( 7, 9) | 1.00 | (reference) |
| 2 months | 837 / 30,124 | 28 | ( 26, 30) | 0.92 | (0.84, 1.01) | 210 / 30,121 | 7 | ( 6, 8) | 0.81 | (0.67, 0.97) |
| 3 months | 313 / 10,604 | 30 | ( 26, 33) | 0.94 | (0.82, 1.07) | 72 / 10,600 | 7 | ( 5, 8) | 0.74 | (0.57, 0.97) |
| 4–6 months | 199 / 6,539 | 30 | ( 26, 35) | 0.95 | (0.81, 1.11) | 55 / 6,537 | 8 | ( 6, 11) | 0.89 | (0.66, 1.20) |
| 7–9 months | 72 / 1,700 | 42 | ( 33, 52) | 1.29 | (1.00, 1.65) | 21 / 1,700 | 12 | ( 7, 18) | 1.23 | (0.79, 1.94) |
| 10–12 months | 42 / 963 | 44 | ( 31, 57) | 1.29 | (0.94, 1.77) | 14 / 962 | 15 | ( 7, 22) | 1.42 | (0.82, 2.44) |
| >12 months | 205 / 3,072 | 67 | ( 58, 76) | 2.03 | (1.73, 2.38) | 82 / 3,066 | 27 | (21, 32) | 2.67 | (2.07, 3.44) |
| |
|
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| Includes 1–7 days exposure category | ||||||||||
| |
|
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| 1–7 days | 64 / 1,391 | 46 | ( 35, 57) | 1.45 | (1.11, 1.89) | 29 / 1,391 | 21 | (13, 28) | 2.38 | (1.60, 3.55) |
| 8–30 days | 807 / 27,176 | 30 | ( 28, 32) | 1.00 | (reference) | 219 / 27,173 | 8 | ( 7, 9) | 1.00 | (reference) |
| 2 months | 685 / 24,644 | 28 | ( 26, 30) | 0.91 | (0.82, 1.02) | 173 / 24,642 | 7 | ( 6, 8) | 0.84 | (0.69, 1.03) |
| 3 months | 265 / 8,666 | 31 | ( 27, 34) | 0.95 | (0.82, 1.09) | 60 / 8,664 | 7 | ( 5, 9) | 0.77 | (0.58, 1.03) |
| 4–6 months | 165 / 5,251 | 31 | ( 27, 36) | 0.97 | (0.82, 1.16) | 46 / 5,249 | 9 | ( 6, 11) | 0.97 | (0.70, 1.34) |
| 7–9 months | 58 / 1,335 | 43 | ( 32, 54) | 1.30 | (0.98, 1.71) | 17 / 1,335 | 13 | ( 7, 19) | 1.30 | (0.79, 2.15) |
| 10–12 months | 37 / 748 | 49 | ( 34, 65) | 1.47 | (1.04, 2.07) | 14 / 747 | 19 | ( 9, 28) | 1.95 | (1.12, 3.39) |
| >12 months | 174 / 2,304 | 76 | ( 65, 86) | 2.24 | (1.88, 2.67) | 72 / 2,300 | 31 | (24, 38) | 3.20 | (2.43, 4.22) |
Abbreviations: Adj, adjusted; CI, confidence interval; CRC, colorectal cancer; FIT, fecal immunochemical test; GI, gastrointestinal; n, number; OR, odds ratio.
Time to colonoscopy intervals [months (days)]: 2 months (31–60 days), 3 months (61–90 days), 4–6 months (91–180 days), 7–9 months (181–272 days), 10–12 months (273–365 days), and >12 months (366–1571 days).
Advanced-stage cancers were defined as stage III (regional lymph node involvement) or stage IV (distant metastasis) according to the American Joint Committee on Cancer staging system or, for those without such staging, as code 3 (disease in the regional lymph nodes), code 4 (regional disease with direct extension and spread to the regional lymph nodes), or code 7 (distant metastasis) according to the SEER Program Coding and Staging Manual 2013.
Cases/Total refers to the number of cases per the total number of patients who had a colonoscopy after a positive FIT.
Rates (and 95% CIs) are per 1,000 patients who had a colonoscopy after a positive FIT.
Adjusted for sex; age; race/ethnicity; body mass index (BMI); region; FIT screening year; completion of previous FIT screening (ever and in the prior year); and in the year prior to FIT screening, receipt of the flu/pneumonia vaccine, presence of gastrointestinal symptoms (bleeding or blood in stool, unexplained weight loss, abdominal pain, diarrhea, diverticulitis, inflammatory bowel disease, or Lynch syndrome), diagnosis of iron-deficiency anemia or diabetes, current smoker, number of primary care visits, and number of days hospitalized. Models for any CRC include the entire population. Models for advanced adenoma exclude 2,191 patients diagnosed with CRC. Models for advanced-stage CRC exclude 14 patients with CRC of unknown stage. Models for stage-specific CRC exclude patients with CRC of any stage other than the specified stage. The adjusted advanced-stage CRC model dropped 244 patients with unknown BMI because no patient with unknown BMI had this outcome. The adjusted models for CRC stages 0, III, and IV dropped 242 patients with unknown BMI because no patient with unknown BMI had these outcomes. The adjusted CRC stage IV model dropped 2435 patients with unknown race/ethnicity because no patient with unknown race/ethnicity had this outcome.