Colonoscopic Findings in Patients with a Positive Fecal Occult Blood Test: A Descriptive Study

Abstract

Introduction. Colorectal cancer is one of the most frequent neoplasms and a serious public health concern worldwide. In 2020, in Argentina, 15,605 new cases of colorectal cancer were registered and, in 2022, 7,217 deaths representing 12% of all deaths from malignant tumors. The National Program for the Prevention and Early Detection of Colorectal Cancer recommends that people between 50 and 75 years of age with no personal or family history of colorectal cancer, no history of inflammatory bowel disease, no suggestive symptoms, and no known risk factors should undergo biennial immunological fecal occult blood test. For at-risk groups, specific evaluations are performed based on their specific needs. A positive result of the immunologic fecal occult blood test requires a colonoscopy, the most sensitive test for early detection.

Aim. To assess the rate of TSOMF-I with a positive result. To describe the percentage of patients who undergo VCC after a positive TSOMF-I result. To assess the adenoma detection rate and prevalence of CRC in patients with TSOMF-I positive.

Materials and methods. A retrospective analysis was performed, in which data were collected from individuals between 50 and 75 years of age with positive immunologic fecal occult blood test and colonoscopies performed at Hospital Pirovano, Ciudad Autónoma de Buenos Aires, from January 1, 2020 to January 1, 2024.

Results. A total of 717 patients were evaluated. A positive result on immunologic fecal occult blood test was observed in 21.6% (n=155) of the cohort, but only 42.6% (n=66) underwent colonoscopy. Findings were identified in 80% of cases, predominantly polyps (36.4%), internal hemorrhoids (34.8%), diverticulosis (18.1%) and angiectasis (4.5%). The prevalence of colorectal cancer was 3%, with an adenoma detection rate of 33.3%. Conclusion. This study showed a high prevalence of colorectal lesions, including adenomas and colorectal cancer, with figures that resemble those published by other international studies. The results obtained reflect the efficacy of immunological fecal occult blood test screening to identify relevant colorectal lesions. A key finding was that less than half of the patients with positive immunological fecal occult blood test underwent subsequent colonoscopy, which indicates the existence of important barriers to access to this study in our setting and reinforces the need to implement strategies to increase it. These findings are crucial to optimizing colorectal cancer screening programs in Argentina, adapting them to the needs of the local population, and improving public health outcomes.