Understanding colorectal cancer risk for symptomatic patients in primary care: A cohort study utilising faecal immunochemical tests and blood results in England

Crooks, Colin J.; Banerjea, Ayan; Jones, James; Chapman, Caroline; Oliver, Simon; West, Joe; Humes, David J.

Abstract

Background: A faecal immunochemical tests (FIT) cut-off of ≥10 μg Hb/g faeces is now recommended in the UK as a gateway to urgent (suspected cancer) investigation for colorectal cancer (CRC), based on an expected CRC risk threshold of 3%. Aims: To quantify the risk of CRC at FIT cut-offs by age, haemoglobin and platelet strata. Methods: A cohort study of a symptomatic CRC pathway based on primary care FIT tests in Nottingham, UK (November 2017–2021) with 1-year follow-up. Heat maps showed the cumulative 1-year CRC risk using Kaplan–Meier estimates. Results: In total, 514 (1.5%) CRCs were diagnosed following 33,694 index FIT requests. Individuals with a FIT ≥ 10 μg Hb/g faeces had a >3% risk of CRC, except patients under the age of 40 years (CRC risk 1.45% [95% CI: 0.03%–2.86%]). Non-anaemic patients with a FIT < 100 μg Hb/g faeces had a CRC risk of <3%, except those between the age of 70 and 85 years (5.26% 95% CI: 2.72%–7.73%). Using a ≥3% CRC threshold in patients <55 years calculated using FIT, age and anaemia might allow 160–220 colonoscopies per 10,000 FITs to be re-purposed, at a cost of missing 1–2 CRCs. Conclusions: FIT alone with a single cut-off is unlikely to be a panacea for optimising CRC diagnosis, as risk varies by FIT, age and anaemia when faecal haemoglobin levels are below 100 μg Hb/g. Tailored FIT cut-offs for investigation on a CRC pathway could reduce the number of investigations needed at a 3% CRC risk threshold.

Citation

Crooks, C. J., Banerjea, A., Jones, J., Chapman, C., Oliver, S., West, J., & Humes, D. J. (2023). Understanding colorectal cancer risk for symptomatic patients in primary care: A cohort study utilising faecal immunochemical tests and blood results in England. Alimentary Pharmacology and Therapeutics, 58(4), 443-452. https://doi.org/10.1111/apt.17632

• Journal Article Type: Article
• Acceptance Date: Jun 22, 2023
• Online Publication Date: Jul 8, 2023
• Publication Date: 2023-08
• Deposit Date: Jun 30, 2023
• Publicly Available Date: Jul 9, 2024
• Journal: Alimentary Pharmacology and Therapeutics
• Print ISSN: 0269-2813
• Electronic ISSN: 1365-2036
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 58
• Issue: 4
• Pages: 443-452
• DOI: https://doi.org/10.1111/apt.17632
• Keywords: colorectal cancer, diagnostic tests, faecal immunochemical tests, cancer diagnosis, epidemiology
• Public URL: https://nottingham-repository.worktribe.com/output/22452633
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/apt.17632
• Additional Information: Received: 2023-04-06; Accepted: 2023-06-22; Published: 2023-07-08