Older age, symptoms or anemia: which factors increase colorectal cancer risk with a positive fecal immunochemical test?

Z Hamarneh, E L Symonds, F Kholmurodova, C Cock
Journal of Gastroenterology and Hepatology 2019 October 12

BACKGROUND: Fecal immunochemical tests (FIT) are used to screen asymptomatic individuals aged 50-74y for colorectal cancer (CRC) within the Australian screening program. Gastrointestinal symptoms or iron deficiency anemia (IDA) may also drive primary care physicians to request a FIT. This study aimed to examine factors that may increase neoplasia risk associated with a positive FIT, specifically age, gastrointestinal symptoms or IDA.

METHODS: A retrospective audit was performed on colonoscopies performed in a single hospital in South Australia for a positive FIT (from all referral sources) between 2014-2017. Patients aged <50y, or who had a colonoscopy in the preceding 5 years, were excluded. A subgroup (n=198) were evaluated to assess whether age ≥75y, symptoms or IDA, as well as other demographics, comorbidities, and medications, were associated with risk of neoplasia. Features found to be associated with risk for CRC or high-risk adenoma (HRA) were examined in the entire cohort using multivariate analysis.

RESULTS: 750/4221 colonoscopies (17.8%) were completed in patients ≥50y for a positive FIT. Of these, 7.6% (n=57) also had gastrointestinal symptoms, 5.5% (n=41) IDA and 13.1% (n=98) were ≥75y. At colonoscopy, 2.8% (n=21) were diagnosed with CRC and 23.2% (n=174) with HRA. CRC was more prevalent in ≥75y compared to 50-74y (7.1% vs 2.1%, p=0.005), and associated with symptoms (15.8% vs 1.7%, p<0.001) and IDA (14.6% vs 2.1%, p<0.001). Multivariate analysis showed that IDA (OR 7.68, p<0.001) and symptoms (OR 10.37, p<0.001), but not age, were independent risk factors for CRC.

CONCLUSION: The presence of gastrointestinal symptoms or IDA, independent of age, are associated with an increased risk for CRC following a positive FIT.


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