Faecal occult blood testing screening for colorectal cancer and ‘missed’ interval cancers: are we ignoring the elephant in the room? Results of a multicentre study

Abstract

A quarter of the colorectal cancers diagnosed in our study were interval cancers. Patients with right-sided interval cancers had the highest proportion of Dukes C and D tumours coupled with the shortest survival time after diagnosis compared with the other groups.

Screen‐detected and interval colorectal cancers in England: Associations with lifestyle and other factors in women in a large UK prospective cohort

“…5 Some may also be fastgrowing, more aggressive lesions which grow to symptomatic size within the 2 year screening interval, although interval cancers as a whole, when compared to cancers detected in an unscreened population, are not reported to be especially large or of higher stage; there are conflicting reports on whether they are or are not associated with worse biological prognostic characteristics or short term survival. 23,24 This study's strengths include its large size, virtually complete follow-up through national registers for deaths and cancers, and unique record linkage combining detailed prospectively-collected information on individual health behavioural factors with screening programme data. We and others have previously found stronger associations for smoking with risk of colorectal cancers other than those coded as adenocarcinoma.…”

“…22 Serrated pathway cancers, which tend to be sited proximally, may be less likely to bleed and perhaps more likely to be fast-growing, and faecal occult blood screening has been shown to perform relatively poorly for their detection. 23,24 This study's strengths include its large size, virtually complete follow-up through national registers for deaths and cancers, and unique record linkage combining detailed prospectively-collected information on individual health behavioural factors with screening programme data. Information was available for tumour site, morphology and for many tumours, also for stage and grade.…”

Ethnic profiles in the National Bowel Cancer Screening Programme – results from a multicentre study

“…We write concerning hitherto unreported ethnic divides in the uptakes and outcomes of the national guaiac‐based faecal occult blood testing (FOBT) screening programme for colorectal cancer (CRC). This was identified as part of a UK‐based multicentre study looking into FOBT and CRC in patients on incident rounds of screening .…”

“…As part of a regional multicentre study into FOBT and IC , data from the National Bowel Cancer Audit Programme (NBOCAP) from three NHS hospitals in the East Midlands region (Queens Medical Centre, Nottingham; Royal Derby Hospital, Derby; Sherwood Forest Hospital NHS Trust, Mansfield) were interrogated to identify all CRCs diagnosed in the screening age group (60–74 years) between August 2011 and 2013. All relevant data on demographics, ethnicity and tumour characteristics from the NBOCAP and hospital information were cross‐referenced with screening history (BCSP Eastern Hub, Queens Medical Centre, Nottingham).…”

Patients with ‘interval’ colorectal cancers have worse outcomes compared with cancers in patients who decline the National Bowel Cancer Screening Programme – Results from a Multicentre Study

“…We write to highlight a unique and inadvertent study finding, that patients on the national guaiac‐based faecal occult blood testing (FOBT) screening programme, who developed interval colorectal cancers (ICs) and in particular right‐sided cancers, had a worse outcome compared with cancers in patients who declined to participate in the national FOBT screening process. This was identified as part of a UK‐based multicentre study looking into FOBT and ICs in patients on incident rounds of screening .…”