Gastro Journal Club: Proximal cancers in FIT-positive patients

For our next installment of the Gastro Journal Club, we are honored to host Professors Willemijn de Klaver and Evelien Dekker from Amsterdam UMC. They are joined by fellows from the Icahn School of Medicine at Mount Sinai for a discussion of the article "Risk of Cancers Proximal to the Colon in Fecal Immunochemical Test Positive Screenees in a Colorectal Cancer Screening Program," published in the September 2024 issue of Gastroenterology.

The Gastro Journal Club is by and for fellows and residents. During these sessions, fellows and residents have the opportunity to ask authors questions about their recently published work in Gastroenterology. If you are interested in arranging a Gastro Journal Club session at your institution, please contact [email protected].

Outline of the meeting:

[0:06] Introduction

[1:00] Discussion of the article

[15:18] How does the Netherlands, as a nation, achieve a low bowel preparation failure rate?

[20:30] What, if any, role does anticoagulation play in FIT positivity, and would it influence these results?

[22:08] How do the authors see the role of FIT changing?

[24:12] The population metrics recorded in the study were age and sex. Was there a reason the authors did not include more data points in the analysis? Is there any plan to follow this up with further analysis, including risk factors for other endoscopically detectable cancers?

[27:29] In this article, FIT was offered every two years instead of annually. What do the authors think the difference would be for people who have serially negative FITs and then undergo colonoscopy after the first positive FIT compared with those whose first FIT is positive?

[32:34] Why did the study not examine mortality and migration as competing events?

[33:57] What does the number needed to scope to detect one EGD-detectable cancer after FIT-based screening mean in terms of time and cost?

[36:35] How do these findings influence the approach to follow-up and surveillance in a practice for FIT-positive patients, especially considering regional or geographic differences in cancer prevalence?

[39:19] What, if any, factors do the authors think might be used to determine whether to pursue EGD in FIT-positive patients in the future?

[41:52] Do the authors expect similar findings for other noninvasive stool-based CRC screening to hold in other studies?

[43:38] In patients where illness was documented, was progression of their illness at advanced stages? Also, are there higher rates of FIT positivity in eastern countries that have higher rates of gastric cancers?

[45:53] What percentage of gastric cancers in the study population were detected by FIT positivity?

[47:28] What do the authors think can explain the association between positive FITs and other cancer types?

[48:45] Has the Netherlands documented an increase in the number of early-onset colorectal cancers in the younger population?

[50:37] Who performs counseling and informed-consent discussions?

[54:29] Given that we see an increase in upper GI cancers in FIT-positive patients, is there a role for things like H. pylori testing when patients are being evaluated for colonoscopy?

[55:29] Conclusion