From the Guidelines
After a positive Fecal Immunochemical Test (FIT) result, the next essential step is to undergo a colonoscopy within 3 months, as recommended by the most recent and highest quality study 1. This follow-up is crucial because a positive FIT indicates the presence of blood in the stool, which could be a sign of colorectal cancer or other significant conditions like polyps, inflammatory bowel disease, or hemorrhoids. The colonoscopy allows a gastroenterologist to directly visualize the entire colon using a flexible tube with a camera, and remove any polyps or take biopsies of suspicious areas during the same procedure. Before the colonoscopy, you'll need to complete a bowel preparation regimen, typically involving a clear liquid diet for 24-48 hours and drinking a prescribed laxative solution to thoroughly clean the colon. You should arrange for someone to drive you home after the procedure since sedation is usually administered. It's essential not to delay this follow-up, as early detection of colorectal cancer significantly improves treatment outcomes, with a higher five-year survival rate when caught early versus when diagnosed at advanced stages 1.
Some key points to consider after a positive FIT result include:
- Participating in confirmatory colonoscopy follow-up, as higher perceived threat, higher cues for action, lower perceived barriers, and higher health behavior scores are associated with participation in confirmatory colonoscopy 1
- Avoiding delays in colonoscopy, as delays of 6 months or longer after a positive FIT have been shown to be associated with higher risks of advanced adenomas, CRC, and advanced stage CRC 1
- Ensuring that at least 80% of patients are offered a date for colonoscopy within 3 months and 100% within 6 months, and that outreach is attempted in 100% of patients within ≤2 weeks of the test results 1
- Informing patients with negative results of the suitable recall interval for future tests 1.
Overall, prioritizing a colonoscopy within 3 months after a positive FIT result is crucial for early detection and treatment of colorectal cancer, and for improving patient outcomes, as supported by the most recent and highest quality study 1.
From the Research
Next Steps After a Positive Fecal Immunochemical Test (FIT) Result
The next steps after a positive FIT result typically involve a follow-up colonoscopy to determine if there are any precancerous or cancerous lesions present.
- A colonoscopy is a crucial step in the screening process for colorectal cancer, as it allows for the visualization of the entire colon and the removal of any detected polyps or lesions 2.
- The timing of the colonoscopy after a positive FIT result can vary, but studies have shown that delays in follow-up colonoscopy may be associated with higher risks of colorectal cancer and advanced-stage disease 3.
- Strategies to improve follow-up after positive FIT results include setting a goal of colonoscopy follow-up within a certain timeframe (e.g., 30 days), tracking FIT-positive patients, early telephone contact to schedule follow-up colonoscopies, and increasing colonoscopy capacity 4.
- Barriers to follow-up colonoscopy can include patient-related factors (e.g., patient decline), provider-related factors (e.g., lack of referral), and system-related factors (e.g., limited colonoscopy capacity) 2, 5, 6.
Importance of Timely Follow-up
Timely follow-up after a positive FIT result is essential to ensure that any potential colorectal cancer or precancerous lesions are detected and treated promptly.
- Studies have shown that delays in follow-up colonoscopy can increase the risk of colorectal cancer and advanced-stage disease 3.
- The risk of colorectal cancer and advanced-stage disease continues to increase with longer delays in follow-up colonoscopy, highlighting the importance of timely follow-up 3.
- Interventions to improve follow-up rates, such as patient navigation and reminder systems, may be necessary to ensure that patients receive timely colonoscopy after a positive FIT result 4, 6.