Symptoms do not predict colorectal cancer in an FOB screened population

Saldanha, JD; Moug, SJ; Linton, K. B.; Diament, R. H.

doi:10.1177/0036933013482638

Cited by 4 publications

(8 citation statements)

References 4 publications

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“…reported that 52% of Scottish FOBT-positive screening participants had CRC-related symptoms. 30 Ahmed et al. described 78% symptomatic FOBT-positive Scottish screening participants.…”

Section: Discussionmentioning

confidence: 99%

“…The two previous studies similarly assessed symptoms in a FOBT‐positive screening population and observed even higher proportions of symptomatic participants. Saldanha et al reported that 52% of Scottish FOBT‐positive screening participants had CRC‐related symptoms 30 . Ahmed et al described 78% symptomatic FOBT‐positive Scottish screening participants 31 .…”

Section: Discussionmentioning

confidence: 99%

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A large proportion of fecal immunochemical test-positive participants in colorectal cancer screening is symptomatic

Klerk

Vlugt

Bossuyt

et al. 2017

United European Gastroenterology Journal

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BackgroundSymptomatic invitees are advised not to participate in colorectal cancer (CRC) screening but to directly consult their general practitioner (GP), because fecal immunochemical test (FIT) sensitivity for cancer is not optimal. This recommendation may not always be followed in daily practice. We evaluated how many FIT-positive participants had CRC-related symptoms and whether the presence of symptoms was associated with the presence and location of CRC/advanced neoplasia.MethodsWe prospectively collected data on CRC-related symptoms in all FIT-positive participants in the Dutch CRC screening program, referred to our endoscopy centers between 2014 and 2016, and evaluated whether symptoms were associated with detected CRC/advanced neoplasia at colonoscopy.ResultsOf 527 FIT-positive participants, 314 had advanced neoplasia, of which 41 had CRC. Overall, 246 (47%; 95% confidence interval (CI) 0.42–0.51) reported CRC-related symptoms. A change in bowel habits (odds ratio (OR) 2.86, CI 1.23–6.62) and visible blood in stool (OR 8.65, CI 2.34–32.0) were associated with the detection of CRC at colonoscopy. We did not observe significant associations between evaluated symptoms and advanced neoplasia.ConclusionsA large proportion of FIT-positive screening participants have CRC-related symptoms. This suggests that current instructions do not retain symptomatic screening invitees from participation and awareness of CRC-related symptoms is inadequate.

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“…reported that 52% of Scottish FOBT-positive screening participants had CRC-related symptoms. 30 Ahmed et al. described 78% symptomatic FOBT-positive Scottish screening participants.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A large proportion of fecal immunochemical test-positive participants in colorectal cancer screening is symptomatic

Klerk

Vlugt

Bossuyt

et al. 2017

United European Gastroenterology Journal

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“…17 In FOBT positive screening populations, the prevalence of bowel symptoms is reported to be between 47% and 78%. [18][19][20][21] Systematic reviews and meta-analyses provide evidence for an association between rectal bleeding and CRC in primary and secondary care, 3 4 22 while other 'alarm symptoms' such as change in bowel habits, abdominal pain and bloating have uncertain diagnostic value. 5 23 The usefulness of symptoms in predicting CRC or advanced adenomas in screening populations is contradictory.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…5 23 The usefulness of symptoms in predicting CRC or advanced adenomas in screening populations is contradictory. [17][18][19][20][21] In addition, there is limited attention on the detection rates among truly asymptomatic individuals in these screening populations.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Detection of cancers and advanced adenomas in asymptomatic participants in colorectal cancer screening: a cross-sectional study

et al. 2021

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ObjectivesTo assess detection rates for colorectal cancer (CRC) and advanced adenomas in asymptomatic CRC screening participants and bowel symptoms in association with CRC and advanced adenoma.DesignCross-sectional study.SettingTwo screening centres.Participants42 554 men and women, aged 50–74 years, participating in a randomised CRC screening trial. 36 059 participants underwent a sigmoidoscopy (and follow-up colonoscopy if positive sigmoidoscopy) and 6495 underwent a colonoscopy after a positive faecal immunochemical test (FIT).Primary and secondary outcome measuresProportion of asymptomatic participants diagnosed with CRC or advanced adenomas. Prevalence of bowel symptoms (rectal bleeding, change in bowel habits, diarrhoea, constipation, bloating, alternating bowel habits, general symptoms, other bowel symptoms) recorded by the endoscopist and their association with CRC and advanced adenomas.ResultsAmong sigmoidoscopy participants, 7336 (20.3%) reported at least one symptom. 120 (60%) out of 200 individuals with screen-detected CRC and 1301 (76.5%) out of 1700 with advanced adenoma were asymptomatic. Rectal bleeding was associated with detection of CRC and advanced adenoma (OR 4.3, 95% CI 3.1 to 6.1 and 1.8, 95% CI 1.5 to 2.1, respectively), while change in bowel habits only with CRC detection (OR 3.8, 95% CI 2.4 to 6.1). Among the FIT positives, 2173 (33.5%) reported at least one symptom. Out of 299 individuals with screen-detected CRC and 1639 with advanced adenoma, 167 (55.9%) and 1 175 (71.7%) were asymptomatic, respectively. Detection of CRC was associated with rectal bleeding (OR 1.8, 95% CI 1.4 to 2.3), change in bowel habits (OR 2.2, 95% CI 1.4 to 3.5) and abdominal pain (OR 1.8, 95% CI 1.2 to 2.7).ConclusionsSome bowel symptoms increased the likelihood of being diagnosed with CRC or advanced adenoma. However, the majority of individuals with these findings were asymptomatic. Asymptomatic individuals should be encouraged to participate in CRC screening.Trial registration numberClinicaltrials.gov Identifier: NCT01538550.

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“…Studies have suggested that large proportions of colorectal cancer screening participants have underlying symptoms [26][27][28] despite recommendations and campaigns for symptomatic individuals to visit their GP. Some of these symptoms can be considered 'low risk, but not no risk' [29] and are often self-limiting but in combination can indicate underlying disease [13,14].…”

Section: Predictorsmentioning

confidence: 99%

The use of electronic healthcare records for colorectal cancer screening referral decisions and risk prediction model development

et al. 2020

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Background The database used for the NHS Bowel Cancer Screening Programme (BCSP) derives participant information from primary care records. Combining predictors with FOBTs has shown to improve referral decisions and accuracy. The richer data available from GP databases could be used to complement screening referral decisions by identifying those at greatest risk of colorectal cancer. We determined the availability of data for key predictors and whether this information could be used to inform more accurate screening referral decisions. Methods An English BCSP cohort was derived using the electronic notifications received from the BCSP database to GP records. The cohort covered a period between 13th May 2009 to 17th January 2017. Completeness of variables and univariable associations were assessed. Risk prediction models were developed using Cox regression and multivariable fractional polynomials with backwards elimination. Optimism adjusted performance metrics were reported. The sensitivity and specificity of a combined approach using the negative FOBT model plus FOBT positive patients was determined using a probability equivalent to a 3% PPV NICE guidelines level. Results 292,059 participants aged 60–74 were derived for the BCSP screening cohort. A model including the screening test result had a C-statistic of 0.860, c-slope of 0.997, and R2 of 0.597. A model developed for negative screening results only had a C-statistic of 0.597, c-slope of 0.940, and R2 of 0.062. Risk predictors included in the models included; age, sex, alcohol consumption, IBS diagnosis, family history of gastrointestinal cancer, smoking status, previous negatives and whether a GP had ordered a blood test. For the combined screening approach, sensitivity increased slightly from 53.90% (FOBT only) to 58.82% but at the expense of an increased referral rate. Conclusions This research has identified several potential predictors for CRC in a BCSP population. A risk prediction model developed for BCSP FOBT negative patients was not clinically useful due to a low sensitivity and increased referral rate. The predictors identified in this study should be investigated in a refined algorithm combining the quantitative FIT result. Combining data from multiple sources enables fuller patient profiles using the primary care and screening database interface.

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Symptoms do not predict colorectal cancer in an FOB screened population

Cited by 4 publications

References 4 publications

A large proportion of fecal immunochemical test-positive participants in colorectal cancer screening is symptomatic

A large proportion of fecal immunochemical test-positive participants in colorectal cancer screening is symptomatic

Detection of cancers and advanced adenomas in asymptomatic participants in colorectal cancer screening: a cross-sectional study

The use of electronic healthcare records for colorectal cancer screening referral decisions and risk prediction model development

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