Colorectal cancer prevalence in faecal immunochemical test non-returners: potential for health inequality in symptomatic referral pathways.

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae119
Adam D Gerrard, Jonty Coxon, Yasuko Maeda, Evropi Theodoratou, Malcolm G Dunlop, Farhat V N Din
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Abstract

Background: This study aimed to describe the faecal immunochemical test non-return rate of those referred with high-risk symptoms of colorectal cancer from primary care, and the clinical outcomes of the 'non-returners'.

Methods: From January 2019 to July 2021, patients referred to secondary care with symptoms suspicious of colorectal cancer and a referral priority of urgent or urgent suspicion of cancer were sent a faecal immunochemical test. All patients were investigated regardless of faecal immunochemical test return or result. Demographics and clinical outcomes such as colorectal cancer prevalence were compared between those who returned a faecal immunochemical test and non-returners.

Results: Of 7345 patients included in the study, 874 (11.9%) did not return a faecal immunochemical test. Non-returner characteristics included male sex (P = 0.040), younger age (median age 57 versus 65 years, P < 0.001), per rectal bleeding (P < 0.001) and lower socioeconomic status (median Scottish Index of Multiple Deprivation, 6 versus 7, P < 0.001) compared with those who returned a faecal immunochemical test. Of 6294 patients undergoing colorectal investigation, there was a greater prevalence of colorectal cancer (5.4% versus 3.6% P = 0.032) and significant bowel pathology than in the non-returners (15.3% versus 9.8%, P < 0.001). With a median follow-up of 25 months, the colorectal cancer prevalence for the entire 7345 cohort was equal between those who returned and did not return a faecal immunochemical test (3.2% versus 3.8%, P = 0.108). Of note, the non-returners diagnosed with colorectal cancer were younger (median age 64 versus 73 years, P < 0.001) and from a lower socioeconomic area (median Scottish Index of Multiple Deprivation 4 versus 7, P = 0.015) than faecal immunochemical test returners.

Conclusion: Patients referred to secondary care, with symptoms suspicious of colorectal cancer, that did not return a faecal immunochemical test had a similar colorectal cancer prevalence to those that returned the test.

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粪便免疫化学检验未返回者的结直肠癌患病率:症状转诊路径中潜在的健康不平等。
背景:本研究旨在描述从初级医疗机构转诊的具有结直肠癌高危症状的患者的粪便免疫化学检验未返回率,以及 "未返回者 "的临床结果:方法:2019 年 1 月至 2021 年 7 月,转诊至二级医疗机构、症状疑似结直肠癌、转诊优先级为紧急或紧急疑似癌症的患者均接受粪便免疫化学检验。无论粪便免疫化学检验结果如何,所有患者均接受了调查。对返回粪便免疫化学检验结果和未返回检验结果的患者的人口统计学和临床结果(如结直肠癌发病率)进行比较:结果:在纳入研究的 7345 名患者中,有 874 人(11.9%)未返回粪便免疫化学检验结果。与返回粪便免疫化学检验的患者相比,未返回者的特征包括男性(P = 0.040)、年龄较小(中位数为 57 岁对 65 岁,P < 0.001)、直肠周围出血(P < 0.001)和社会经济地位较低(苏格兰多重贫困指数中位数为 6 对 7,P < 0.001)。在接受结直肠检查的 6294 名患者中,结直肠癌(5.4% 对 3.6%,P = 0.032)和明显肠道病变的发病率高于未返回者(15.3% 对 9.8%,P < 0.001)。中位随访时间为 25 个月,在整个 7345 群体中,返回和未返回粪便免疫化学检验者的结直肠癌发病率相同(3.2% 对 3.8%,P = 0.108)。值得注意的是,与粪便免疫化学检验结果送检者相比,未送检者被确诊为结直肠癌的年龄更小(中位年龄为 64 岁对 73 岁,P < 0.001),社会经济地位更低(苏格兰多重贫困指数中位数为 4 对 7,P = 0.015):结论:有结直肠癌可疑症状但未返回粪便免疫化学检验结果的转诊到二级医疗机构的患者,其结直肠癌发病率与返回检验结果的患者相似。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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