FIT negative cancers: A right-sided problem? Implications for screening and whether iron deficiency anaemia has a role to play

Cunin, Laila; Khan, Aftab Alam; Ibrahim, Maria; Lango, Artemisia; Klimovskij, Michail; Harshen, Raj

doi:10.1016/j.surge.2020.02.003

Cited by 17 publications

(19 citation statements)

References 14 publications

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“…In addition, faecal immunohistochemistry testing, which continued largely unabated during the slowdown, has been demonstrated in multiple studies to have worse detection rates for right-sided colon cancers. ( 18 , 19 ) Since colonoscopies during the slowdown were limited to patients who were symptomatic or who had a positive FIT test, it is logical that these patients would not have presented to the health care system until they had severe complications.…”

Section: Discussionmentioning

confidence: 99%

Negative Impact of COVID-19 Associated Health System Shutdown on Patients Diagnosed With Colorectal Cancer: A Retrospective Study From a Large Tertiary Center in Ontario, Canada

Forse

Petkiewicz

Teo

et al. 2021

Journal of the Canadian Association of Gastroenterology

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Background In March 2020, a directive to halt all elective and non-urgent procedures was issued in Ontario, Canada because of COVID-19. The directive caused a temporary slowdown of screening programs including surveillance colonoscopies for colorectal cancer (CRC). Our goal was to determine if there was a difference in patient and tumour characteristics between CRC patients treated surgically prior to the COVID-19 directive compared to CRC patients treated after the slowdown. Methods CRC resections collected within the Champlain catchment area of eastern Ontario in the 6 months prior to COVID-19 (August 1, 2019–January 31, 2020) were compared to CRC resections collected in the 6 months post-COVID-19 slowdown (August 1, 2020–January 31, 2021). Clinical (e.g., gender, patient age, tumour site, and clinical presentation) and pathological (tumour size, tumour stage, nodal stage, and lymphovascular invasion) features were evaluated using chi-square tests, T-tests, and Mann–Whitney tests where appropriate. Results Three hundred and thirty-eight CRC specimens were identified (173 pre-COVID-19, 165 post-COVID-19 slowdown). CRC patients treated surgically post-COVID-19 slowdown had larger tumours (44 mm vs. 35 mm; P = 0.0048) and were more likely to have presented emergently (24% vs. 10%; P < 0.001). Although there was a trend towards higher tumour stage, nodal stage, and clinical stage, these differences did not reach statistical significance. Other demographic and pathologic variables including patient gender, age, and tumour site were similar between the two cohorts. Interpretation The COVID-19 slowdown resulted in a shift in the severity of disease experienced by CRC patients in Ontario. Pandemic planning in the future should consider the long-term consequences to cancer diagnosis and management.

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Section: Discussionmentioning

confidence: 99%

Negative Impact of COVID-19 Associated Health System Shutdown on Patients Diagnosed With Colorectal Cancer: A Retrospective Study From a Large Tertiary Center in Ontario, Canada

Forse

Petkiewicz

Teo

et al. 2021

Journal of the Canadian Association of Gastroenterology

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“…The introduction of faecal immunochemical testing (FIT) for trace quantities of blood in the stool has provided a major step forward in risk stratification for those presenting with clinical features that are potentially due to colorectal cancer (CRC), and the value of it has been demonstrated in a series of large observational studies. [64][65][66][67][68][69] FIT is currently recommended by NICE for determining whether IDA in the under-60 age group warrants fast-track referral 23 -while this suggestion is logical, the evidence base is limited.…”

Section: Role Of Faecal Immunochemical Testingmentioning

confidence: 99%

“…Second, data from six recently published studies of real-world experience confirm that even at the low detection threshold of 10 µg/g, the sensitivity of FIT for CRC ranges from 83% to 91%. [64][65][66][67][68][69] Furthermore, although numbers are small, there is the suspicion that IDA may be over-represented in the FIT negative CRC subgroup, accounting for 32 (40%) of the 81 pooled cases. The data are summarised in table 2.…”

Section: Guidelinesmentioning

confidence: 99%

British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

Snook

Bhala

Beales

et al. 2021

Gut

159

111

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Iron deficiency anaemia (IDA) is a major cause of morbidity and burden of disease worldwide. It can generally be diagnosed by blood testing and remedied by iron replacement therapy (IRT) using the oral or intravenous route. The many causes of iron deficiency include poor dietary intake and malabsorption of dietary iron, as well as a number of significant gastrointestinal (GI) pathologies. Because blood is iron-rich it can result from chronic blood loss, and this is a common mechanism underlying the development of IDA—for example, as a consequence of menstrual or GI blood loss.Approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly in the GI tract. Therefore optimal management of IDA requires IRT in combination with appropriate investigation to establish the underlying cause. Unexplained IDA in all at-risk individuals is an accepted indication for fast-track secondary care referral in the UK because GI malignancies can present in this way, often in the absence of specific symptoms. Bidirectional GI endoscopy is the standard diagnostic approach to examination of the upper and lower GI tract, though radiological scanning is an alternative in some situations for assessing the large bowel. In recurrent or refractory IDA, wireless capsule endoscopy plays an important role in assessment of the small bowel.IDA may present in primary care or across a range of specialties in secondary care, and because of this and the insidious nature of the condition it has not always been optimally managed despite the considerable burden of disease— with investigation sometimes being inappropriate, incorrectly timed or incomplete, and the role of IRT for symptom relief neglected. It is therefore important that contemporary guidelines for the management of IDA are available to all clinicians. This document is a revision of previous British Society of Gastroenterology guidelines, updated in the light of subsequent evidence and developments.

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“…for ≥10 μg Hb/g FIT threshold, for CRC, sensitivity 90.5%, specificity 91.3%, positive predictive value 10.1% and negative predictive value 99.9%), with little evidence of age or gender affecting performance (45,46). Furthermore, sensitivity and specificity have been shown to be similar between those presenting with IDA and those referred with other symptoms (47). Importantly, in patients with IDA specifically, FIT has a high negative predictive value (98.4%) with a ≥10 μg Hb/g threshold(48••).…”

Section: Managementmentioning

confidence: 98%

Iron deficiency: a modern primer to diagnosis and management

Alexandre

Chan

2020

Current Opinion in Gastroenterology

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Iron deficiency (ID) with (IDA) and without anemia (IDWA) remain a diagnostic and management challenge. ID has a broad spectrum of causes, including gastrointestinal malignancy. The purpose of this review is to summarise the value and limitations of current methods to diagnose ID and underline the relevance of contemporaneous evidence to guide the pre-test probability of gastrointestinal disease. Recent findingsA number of biomarkers for iron deficiency exist, and all have their caveats. Serum ferritin remains the most pragmatic means of diagnosing iron deficiency. Hepcidin holds future promise as a marker of iron status during inflammatory states. Men and post-menopausal women with IDA have the highest overall prevalence of gastrointestinal malignancy (~11%), while premenopausal women with IDA (<1.5%) and those with IDWA (<0.5%) have a very low risk. Non-invasive investigation with fecal immunochemical test (FIT) and fecal calprotectin (FC) hold promise to guide further investigations in lower risk groups.

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FIT negative cancers: A right-sided problem? Implications for screening and whether iron deficiency anaemia has a role to play

Cited by 17 publications

References 14 publications

Negative Impact of COVID-19 Associated Health System Shutdown on Patients Diagnosed With Colorectal Cancer: A Retrospective Study From a Large Tertiary Center in Ontario, Canada

Negative Impact of COVID-19 Associated Health System Shutdown on Patients Diagnosed With Colorectal Cancer: A Retrospective Study From a Large Tertiary Center in Ontario, Canada

British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults

Iron deficiency: a modern primer to diagnosis and management

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