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Lykkegaard J, Olsen JK, Wehberg S, Jarbøl DE. The durability of previous examinations for cancer: Danish nationwide cohort study. Scand J Prim Health Care 2024; 42:246-253. [PMID: 38251839 PMCID: PMC11003324 DOI: 10.1080/02813432.2024.2305942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Patients previously examined for cancer with a negative result may present in general practice with ongoing or new symptoms or signs suggestive of cancer. This paper explores the potential existence of a relatively safe period for cancer occurrence after receiving negative examination results for specific types of cancer, including lung (CT thorax), upper gastrointestinal (gastroscopy), colorectal (colonoscopy), bladder (cystoscopy), and breast (clinical mammography). DESIGN Register-based time-to-event analyses. SETTING Denmark. SUBJECTS All 3.3 million citizens aged 30-85 years who on January first, 2017, had not previously been diagnosed with the specific type of cancer were categorized based on the time since their most recent examination. MAIN OUTCOME MEASURES Using 1-year follow-up, we calculated the age- and sex-adjusted hazard ratios of being diagnosed with the related cancer, with non-examined individuals as reference. Negative examination results were defined as the absence of a cancer diagnosis within 6 months following the examination. RESULTS Previous negative examination results were common, also among those diagnosed with cancer during follow-up. For 10 years after a negative colonoscopy the risk of diagnosing a colorectal cancer was nearly halved. However, already 1 year after a clinical mammography and 2 years after a CT thorax the risk of diagnosing the related cancers was significantly higher among those with a previous negative result compared to non-examined individuals. CONCLUSION This study did not identify a post-examination period in which the cancer risk, compared to non-examined individuals, was sufficiently low to confidently rule out any of the investigated cancers.
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Affiliation(s)
- Jesper Lykkegaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jonas Kanstrup Olsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Baronas VA, Arif AA, Bhang E, Ladua GK, Brown CJ, Donnellan F, Gill S, Stuart HC, Loree JM. Symptom Burden and Time from Symptom Onset to Cancer Diagnosis in Patients with Early-Onset Colorectal Cancer: A Multicenter Retrospective Analysis. Curr Oncol 2024; 31:2133-2144. [PMID: 38668061 PMCID: PMC11049268 DOI: 10.3390/curroncol31040158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The incidence of colorectal cancer (CRC) is decreasing in individuals >50 years due to organised screening but has increased for younger individuals. We characterized symptoms and their timing before diagnosis in young individuals. Methods: We identified all patients diagnosed with CRC between 1990-2017 in British Columbia, Canada. Individuals <50 years (n = 2544, EoCRC) and a matched cohort >50 (n = 2570, LoCRC) underwent chart review to identify CRC related symptoms at diagnosis and determine time from symptom onset to diagnosis. Results: Across all stages of CRC, EoCRC presented with significantly more symptoms than LoCRC (Stage 1 mean ± SD: 1.3 ± 0.9 vs. 0.7 ± 0.9, p = 0.0008; Stage 4: 3.3 ± 1.5 vs. 2.3 ± 1.7, p < 0.0001). Greater symptom burden at diagnosis was associated with worse survival in both EoCRC (p < 0.0001) and LoCRC (p < 0.0001). When controlling for cancer stage, both age (HR 0.87, 95% CI 0.8-1.0, p = 0.008) and increasing symptom number were independently associated with worse survival in multivariate models. Conclusions: Patients with EoCRC present with a greater number of symptoms of longer duration than LoCRC; however, time from patient reported symptom onset was not associated with worse outcomes.
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Affiliation(s)
- Victoria A. Baronas
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V6T1Z4, Canada; (V.A.B.); (A.A.A.); (E.B.); (G.K.L.); (C.J.B.); (F.D.); (S.G.)
| | - Arif A. Arif
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V6T1Z4, Canada; (V.A.B.); (A.A.A.); (E.B.); (G.K.L.); (C.J.B.); (F.D.); (S.G.)
| | - Eric Bhang
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V6T1Z4, Canada; (V.A.B.); (A.A.A.); (E.B.); (G.K.L.); (C.J.B.); (F.D.); (S.G.)
| | - Gale K. Ladua
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V6T1Z4, Canada; (V.A.B.); (A.A.A.); (E.B.); (G.K.L.); (C.J.B.); (F.D.); (S.G.)
| | - Carl J. Brown
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V6T1Z4, Canada; (V.A.B.); (A.A.A.); (E.B.); (G.K.L.); (C.J.B.); (F.D.); (S.G.)
- Department of Surgery, Division of General Surgery, St. Paul’s Hospital, Vancouver, BC V6Z1Y6, Canada
| | - Fergal Donnellan
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V6T1Z4, Canada; (V.A.B.); (A.A.A.); (E.B.); (G.K.L.); (C.J.B.); (F.D.); (S.G.)
- Division of Gastroenterology, Vancouver General Hospital, Vancouver, BC V5Z1M9, Canada
| | - Sharlene Gill
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V6T1Z4, Canada; (V.A.B.); (A.A.A.); (E.B.); (G.K.L.); (C.J.B.); (F.D.); (S.G.)
- BC Cancer, Vancouver, BC V6E1Y6, Canada
| | - Heather C. Stuart
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V6T1Z4, Canada; (V.A.B.); (A.A.A.); (E.B.); (G.K.L.); (C.J.B.); (F.D.); (S.G.)
- BC Cancer, Vancouver, BC V6E1Y6, Canada
| | - Jonathan M. Loree
- Division of Gastroenterology, University of British Columbia, Vancouver, BC V6T1Z4, Canada; (V.A.B.); (A.A.A.); (E.B.); (G.K.L.); (C.J.B.); (F.D.); (S.G.)
- BC Cancer, Vancouver, BC V6E1Y6, Canada
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Uebel L, Kromodikoro I, Nyhlin N, van Nieuwenhoven M. Colorectal Cancer Fast Tracks: Cancer Yield and the Predictive Value of Entry Criteria. Cancers (Basel) 2023; 15:4778. [PMID: 37835472 PMCID: PMC10571709 DOI: 10.3390/cancers15194778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Fast-track pathways for diagnosing colorectal cancer (CRC) have been implemented in several European countries. In Sweden, a substantial number of CRC are diagnosed via the Swedish Standardized Course of Care for colorectal cancer (SCC-CRC). We evaluated the SCC-CRC in terms of CRC yield, and predictive values and odds ratios (OR) for the entry criteria. METHODS We retrospectively analyzed all 2539 patients referred for SCC-CRC colonoscopy between September 2016 and December 2020. Entry criteria and colonoscopy outcomes were analyzed. RESULTS CRC yield was 16.4%. Highest positive predictive values (PPVs) were seen for abnormal radiology (PPV 30.5%, OR 4.7 (95% CI 3.4-6.4) p < 0.001), abnormal rectal examination (PPV 28%, OR 3.6 (95% CI 2.7-4.8) p < 0.001), and anemia (PPV 24.8%, OR 2.2 (95% CI 1.5-3.1) p < 0.001). Some entry criteria showed no significant risk increase, i.e., visible blood in stool/rectal bleeding, change in bowel habits, and the combination of changed bowel habits plus anemia. A positive fecal immunochemical test (FIT), although not part of the SCC-CRC, showed the highest OR: 9.9 (95% CI 4.5-21.7) p < 0.001) and PPV of 18.8%. CONCLUSIONS CRC yield from the SCC-CRC is slightly higher compared to other European fast tracks. A number of entry criteria showed no benefit towards assessing CRC risk. FIT testing should be included in CRC fast tracks to increase diagnostic efficacy.
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Affiliation(s)
- Linnea Uebel
- Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, SE 70116 Örebro, Sweden; (L.U.)
| | - Indy Kromodikoro
- Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, SE 70116 Örebro, Sweden; (L.U.)
| | - Nils Nyhlin
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
| | - Michiel van Nieuwenhoven
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
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White B, Renzi C, Barclay M, Lyratzopoulos G. Underlying cancer risk among patients with fatigue and other vague symptoms: a population-based cohort study in primary care. Br J Gen Pract 2023; 73:e75-e87. [PMID: 36702593 PMCID: PMC9888575 DOI: 10.3399/bjgp.2022.0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/17/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Presenting to primary care with fatigue is associated with slightly increased cancer risk, although it is unknown how this varies in the presence of other 'vague' symptoms. AIM To quantify cancer risk in patients with fatigue who present with other 'vague' symptoms in the absence of 'alarm' symptoms for cancer. DESIGN AND SETTING Cohort study of patients presenting in UK primary care with new-onset fatigue during 2007-2015, using Clinical Practice Research Datalink data linked to national cancer registration data. METHOD Patients presenting with fatigue without co-occurring alarm symptoms or anaemia were identified, who were further characterised as having co-occurrence of 19 other 'vague' potential cancer symptoms. Sex- and age-specific 9-month cancer risk for each fatigue-vague symptom cohort were calculated. RESULTS Of 285 382 patients presenting with new-onset fatigue, 84% (n = 239 846) did not have co-occurring alarm symptoms or anaemia. Of these, 38% (n = 90 828) presented with ≥1 of 19 vague symptoms for cancer. Cancer risk exceeded 3% in older males with fatigue combined with any of the vague symptoms studied. The age at which risk exceeded 3% was 59 years for fatigue-weight loss, 65 years for fatigue-abdominal pain, 67 years for fatigue-constipation, and 67 years for fatigue-other upper gastrointestinal symptoms. For females, risk exceeded 3% only in older patients with fatigue-weight loss (from 65 years), fatigue-abdominal pain (from 79 years), or fatigue-abdominal bloating (from 80 years). CONCLUSION In the absence of alarm symptoms or anaemia, fatigue combined with specific vague presenting symptoms, alongside patient age and sex, can guide clinical decisions about referral for suspected cancer.
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Affiliation(s)
- Becky White
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, UK
| | - Cristina Renzi
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, UK, and associate professor, Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Matthew Barclay
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, UK
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Muacevic A, Adler JR, Bu Hulayqah ZHM, Algharsan FAG, Alghamdi HA, Alzahrani HA. Public Awareness of Colorectal Cancer Screening in the Al-Baha Region, Saudi Arabia, 2022. Cureus 2022; 14:e32386. [PMID: 36632269 PMCID: PMC9829443 DOI: 10.7759/cureus.32386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND According to the WHO, cancer is ranked as the second leading cause of death, accounting for an estimated 9.6 million deaths in 2018. This study aimed to assess public awareness about colorectal cancer (CRC) screening and the barriers that prevent Saudi individuals from undergoing CRC screening. Materials and methods: A cross-sectional study was conducted in the Prince Mishari Bin Saud General Baljurashi Hospital, and a supervised self-administered questionnaire was utilized. Sociodemographic data, knowledge about colorectal cancer, and attitude toward screening were included in the survey. Data were analyzed using IBM SPSS Version 23 (SPSS Inc., Chicago, IL, USA) and Pearson's chi-square test. A P<0.05 was considered statistically significant. RESULTS A total of 396 eligible participants completed the survey. About 209 (52%) were female, and 124 (31.3%) belonged to the age group of 18-29 years. Nearly (49.7%) knew that detecting colorectal cancer before symptoms appear is possible. About 64% of the participants cited colonoscopy as the screening method for CRC. More than half of the participants (58.1%) expressed their willingness to be screened for colorectal cancer, while only 2.8% reported that they had undergone screening before. Participants with higher educational status demonstrated better knowledge regarding CRC than others (p<0.05). CONCLUSION The overall knowledge of CRC was found to be poor in Al-Baha residents, irrespective of age. Implementing new strategies to increase public awareness about colorectal cancer will aid in the early diagnosis of CRC. We recommend targeted education and screening programs to improve the level of screening awareness and aid in the early diagnosis of colorectal cancer.
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Booth R, Carten R, D'Souza N, Westwood M, Kleijnen J, Abulafi M. Role of the faecal immunochemical test in patients with risk-stratified suspected colorectal cancer symptoms: A systematic review and meta-analysis to inform the ACPGBI/BSG guidelines. THE LANCET REGIONAL HEALTH. EUROPE 2022; 23:100518. [PMID: 36212984 PMCID: PMC9535300 DOI: 10.1016/j.lanepe.2022.100518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background The UK National Institute for Health and Care Excellence (NICE), recommended in 2017 the use of the faecal immunochemical test (FIT) to guide investigations in patients presenting with NICE-defined low-risk symptoms suspicious for colorectal cancer (CRC). At that time, NICE did not recommend FIT use for high-risk symptoms. This is the first systematic review to evaluate the diagnostic accuracy of FIT in NICE-defined high and low-risk symptoms and was designed to inform the joint ACPGBI/BSG guidelines. Methods We performed a systematic literature review and meta-analysis. PROSPERO registration number CRD42021224674. Medline and EMBASE databases were searched from inception to 31st March 2022. We included studies recruiting adult patients presenting with suspected CRC symptoms in whom FIT was performed and diagnostic accuracy data for CRC detection could be derived at a limit of detection (LoD) and/or 10 µg haemoglobin/gram faeces threshold in four commonly used analysers. FIT performance was assessed for high-risk, low-risk and individual symptoms where possible. Bivariate meta-analysis was performed where study numbers allowed. Findings Thirty-one studies (79566 patients) met inclusion criteria. At 10 µg/g, for "all symptoms" (n = 35,945) sensitivity and specificity were 91.0% (95% CI: 88.9, 92.7) and 75.2% (95% CI: 69.6, 80.1); for "high-risk" symptoms (n = 18,264), 88.7% (95% CI: 84.4, 92.0) and 78.5% (95% CI: 73.0, 83.2); and for "low-risk" symptoms (n = 2161), 88.7% (95% CI: 78.1, 95.3) and 88.5% (95% CI: 87.1, 89.9), respectively. At LoD, for "all symptoms" (n = 26,056) sensitivity and specificity were 94.7% (95% CI: 90.5, 97.1) and 66.5% (95% CI: 58.7, 73.6); for "high-risk" symptoms (n = 16,768), 92.8% (95% CI: 86.4, 96.3) and 70.3% (95% CI: 66.5, 73.8); and for "low-risk" symptoms (n = 2082), 94.7% (95% CI: 85.4, 98.9) and 71.9% (95% CI: 69.9, 73.9), respectively. Summary estimates were similar across different analysers. Interpretation FIT sensitivity for CRC detection is maximised at the LoD; its performance is similar in high and low-risk symptoms, and across different analysers where a common threshold is used. FIT performance for CRC detection is adequate and transferrable to clinical diagnostic pathways. Funding This review was part-funded by NHS England awarded to RM Partners. RB and RC were funded by research fellowships awarded by Croydon University Hospital.
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Jarbøl DE, Hyldig N, Möller S, Wehberg S, Rasmussen S, Balasubramaniam K, Haastrup PF, Søndergaard J, Rubin KH. Can National Registries Contribute to Predict the Risk of Cancer? The Cancer Risk Assessment Model (CRAM). Cancers (Basel) 2022; 14:cancers14153823. [PMID: 35954486 PMCID: PMC9367495 DOI: 10.3390/cancers14153823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/31/2022] [Accepted: 08/04/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Early identification of individuals with an increased risk of cancer is an important challenge. Danish administrative registers may be useful in this respect because they cover the entire population and include comprehensive and consistently coded long-term data. We aimed to develop a predictive model based on Danish administrative registers to facilitate the automated identification of individuals at risk of any type of cancer. In addition to age, almost all the included factors contributed statistically significantly, but also only marginally, to the prediction models, which means that we have not overlooked obvious information available in the register. Future prediction studies should focus on specific cancer types where more precise risk estimations might be expected. It is our ultimate ambition that an effective model can be used at the point of care, integrated into electronic patient record systems to alert physicians of patients at a high risk of cancer. Abstract Purpose: To develop a predictive model based on Danish administrative registers to facilitate automated identification of individuals at risk of any type of cancer. Methods: A nationwide register-based cohort study covering all individuals in Denmark aged +20 years. The outcome was all-type cancer during 2017 excluding nonmelanoma skin cancer. Diagnoses, medication, and contact with general practitioners in the exposure period (2007–2016) were considered for the predictive model. We applied backward selection to all variables by logistic regression to develop a risk model for cancer. We applied the models to the validation cohort, calculated the receiver operating characteristic curves, and estimated the corresponding areas under the curve (AUC). Results: The study population consisted of 4.2 million persons; 32,447 (0.76%) were diagnosed with cancer in 2017. We identified 39 predictive risk factors in women and 42 in men, with age above 30 as the strongest predictor for cancer. Testing the model for cancer risk showed modest accuracy, with an AUC of 0.82 (95% CI 0.81–0.82) for men and 0.75 (95% CI 0.74–0.75) for women. Conclusion: We have developed and tested a model for identifying the individual risk of cancer through the use of administrative data. The models need to be further investigated before being applied to clinical practice.
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Affiliation(s)
- Dorte E. Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence:
| | - Nana Hyldig
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
| | - Sören Möller
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Peter F. Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Katrine H. Rubin
- OPEN—Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
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Gvirtzman R, Livovsky DM, Tahover E, Goldin E, Koslowsky B. Anemia can predict the prognosis of colorectal cancer in the pre-operative stage: a retrospective analysis. World J Surg Oncol 2021; 19:341. [PMID: 34876136 PMCID: PMC8653538 DOI: 10.1186/s12957-021-02452-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/22/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Early detection of colorectal cancer (CRC) improves prognosis, yet many CRCs are diagnosed following symptoms. The aim of this study was to determine which CRC-related symptoms or signs can predict an advanced CRC in the pre-operative stage. METHODS Retrospective analysis of 300 patients who underwent surgery for CRC between the years 2008 and 2019. Patients' symptoms prior to CRC diagnosis were documented. Primary endpoint was the association of signs or/and symptoms with CRC diagnosis at TNM stages of 2-4 (i.e., highly advanced), compared to TNM score of 0-1 (i.e., locally advanced). RESULTS Three hundred patients, 91 with locally advanced and 209 with highly advanced CRC, were enrolled. There was a significant correlation between highly advanced CRC, compared to locally advanced, regarding tumor size (4.8 vs. 2.6 cm, p<0.001), presentation of any symptom prior to diagnosis (77% vs. 54%, p<0.001), anemia (46% vs. 29%, p=0.004), and severe anemia (17% vs. 4%, p=0.002). Mean hemoglobin was 12.2 ± 2.2 and 13.1 ± 1.8 in the highly advanced compared to locally advanced CRC, respectively, p<0.001. Anemia correlated with the T stage of the tumor: 21% of patients diagnosed at stages 0-1 had anemia, 39% at stage 2, 44% at stage 3, and 66% at stage 4 (p=0.001). CONCLUSIONS Anemia is the only finding that correlates with highly advanced CRC, in the pre-operative stage. When CRC has been diagnosed, the presence of anemia, at any level, may be considered in determining prognosis at the pre-operative stage. Physicians should be aware that when anemia is present, the risk for highly advanced CRC increases, and therefore should pursue with CRC detection.
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Affiliation(s)
- Rotem Gvirtzman
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Dan Meir Livovsky
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Esther Tahover
- Faculty of Medicine, Hebrew University of Jerusalem, Oncology Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Eran Goldin
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Benjamin Koslowsky
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare-Zedek Medical Center, Jerusalem, Israel.
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Haq MS, Thomas PM, Almonte M, Mohan V. Prostate Cancer Presenting With an Unusual Presentation of Rectal Pain and Bleeding. Cureus 2021; 13:e18766. [PMID: 34804647 PMCID: PMC8592291 DOI: 10.7759/cureus.18766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 12/03/2022] Open
Abstract
We report an atypical case of prostate cancer with rectal involvement presenting with gastrointestinal symptoms predominately and a rectal mass. A 51-year-old male patient came to the hospital with abdominal pain and rectal bleeding. Imaging revealed prostate enlargement, perirectal lymphadenopathy, and multiple hepatic and pulmonary nodules. The patient also had an elevated prostate-specific antigen (PSA) of 502 ng/mL (against normal range 0.6-0.7 ng/mL). Biopsies were performed on tissue samples taken from the rectum and prostate gland, which confirmed the diagnosis of prostate adenocarcinoma. The lack of urinary symptoms and close clinical similarity to colorectal cancer presented a diagnostic challenge for us. Familiarity with this specific presentation of prostate cancer is necessary to avoid misdiagnoses and guide correct treatment.
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Affiliation(s)
- Muhammad S Haq
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | - Pravin M Thomas
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | - Marcos Almonte
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | - Vinuta Mohan
- Internal Medicine: Endocrinology, Saint Francis Medical Center, Trenton, USA
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Larsen MB, Bachmann HH, Søborg B, Laurberg T, Emmertsen KJ, Laurberg S, Andersen B. Prevalence of self-reported abdominal symptoms among 50-74-years-old men and women eligible for colorectal cancer screening -a cross-sectional study. BMC Cancer 2021; 21:910. [PMID: 34376179 PMCID: PMC8356437 DOI: 10.1186/s12885-021-08657-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/27/2021] [Indexed: 12/22/2022] Open
Abstract
Background Screening is defined as the identification of unrecognized disease in an apparently healthy population. Symptomatic individuals are recommended to contact a physician instead of participating in screening. However, in colorectal cancer (CRC) screening this approach may be problematic as abdominal symptoms are nonspecific. This study aimed at identifying the prevalence of self-reported abdominal symptoms among screening-eligible men and women aged 50–74 years. Methods This cross-sectional survey study included 11,537 individuals aged 50–74 years invited for CRC screening from 9 to 23 September 2019. Descriptive statistics of responders experiencing alarm symptoms of CRC, Low Anterior Resection Syndrome Score (LARS) and the Patient Assessment of Constipation-Symptoms (PAC-SYM) were derived. The association between abdominal symptoms and demographic and socioeconomic variables were estimated by prevalence ratio (PR) using a Poisson regression model with robust variance. Results A total of 5488 respondents were included. The respondents were more likely women, of older age, Danish, cohabiting and had higher education and income level compared to non-respondents. Abdominal pain more than once a week was experienced by 12.0% of the respondents. Of these, 70.8% had been experiencing this symptom for >1 month. Fresh blood in the stool was experienced by 0.7% and of these 82.1% for >1 month. About one third of those experiencing alarm symptoms more than once a week for >1 month had not consulted a doctor. A total of 64.1% of the respondents had no LARS, 21.7% had minor LARS and 14.2% had major LARS. The median PAC-SYM score was 0.33 (Interquartile range (IQR): 0.17;0.75), the median abdominal score was 0.50 (IQR: 0.00;1.00), median rectal score 0.00 (IQR:0.00;0.33) and median stool score 0.40 (IQR: 0.00;0.80). Men and those aged 65–74 reported less symptoms than women and those aged 50–64 years, respectively. Conclusions This study illustrated that abdominal symptoms were frequent among screening-eligible men and women. This should be taken into account when implementing and improving CRC screening strategies. A concerning high number of the respondents experiencing alarm symptoms had not consulted a doctor. This calls for attention to abdominal symptoms in general and how those with abdominal symptoms should participate in CRC screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08657-z.
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Affiliation(s)
- Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark.
| | - Heidi Heinsen Bachmann
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark
| | - Bo Søborg
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark
| | - Tinne Laurberg
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, DK-8200, Aarhus N, Denmark
| | - Katrine J Emmertsen
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, DK-8200, Aarhus N, Denmark.,Department of Surgery, Randers Regional Hospital, Skovlyvej 1, NO, DK-8930, Randers, Denmark
| | - Søren Laurberg
- Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, DK-8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, NO, DK-8930, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
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11
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Herbert A, Rafiq M, Pham TM, Renzi C, Abel GA, Price S, Hamilton W, Petersen I, Lyratzopoulos G. Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: A cohort study. PLoS Med 2021; 18:e1003708. [PMID: 34339405 PMCID: PMC8367005 DOI: 10.1371/journal.pmed.1003708] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 08/16/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The diagnostic assessment of abdominal symptoms in primary care presents a challenge. Evidence is needed about the positive predictive values (PPVs) of abdominal symptoms for different cancers and inflammatory bowel disease (IBD). METHODS AND FINDINGS Using data from The Health Improvement Network (THIN) in the United Kingdom (2000-2017), we estimated the PPVs for diagnosis of (i) cancer (overall and for different cancer sites); (ii) IBD; and (iii) either cancer or IBD in the year post-consultation with each of 6 abdominal symptoms: dysphagia (n = 86,193 patients), abdominal bloating/distension (n = 100,856), change in bowel habit (n = 106,715), rectal bleeding (n = 235,094), dyspepsia (n = 517,326), and abdominal pain (n = 890,490). The median age ranged from 54 (abdominal pain) to 63 years (dysphagia and change in bowel habit); the ratio of women/men ranged from 50%:50% (rectal bleeding) to 73%:27% (abdominal bloating/distension). Across all studied symptoms, the risk of diagnosis of cancer and the risk of diagnosis of IBD were of similar magnitude, particularly in women, and younger men. Estimated PPVs were greatest for change in bowel habit in men (4.64% cancer and 2.82% IBD) and for rectal bleeding in women (2.39% cancer and 2.57% IBD) and lowest for dyspepsia (for cancer: 1.41% men and 1.03% women; for IBD: 0.89% men and 1.00% women). Considering PPVs for specific cancers, change in bowel habit and rectal bleeding had the highest PPVs for colon and rectal cancer; dysphagia for esophageal cancer; and abdominal bloating/distension (in women) for ovarian cancer. The highest PPVs of abdominal pain (either sex) and abdominal bloating/distension (men only) were for non-abdominal cancer sites. For the composite outcome of diagnosis of either cancer or IBD, PPVs of rectal bleeding exceeded the National Institute of Health and Care Excellence (NICE)-recommended specialist referral threshold of 3% in all age-sex strata, as did PPVs of abdominal pain, change in bowel habit, and dyspepsia, in those aged 60 years and over. Study limitations include reliance on accuracy and completeness of coding of symptoms and disease outcomes. CONCLUSIONS Based on evidence from more than 1.9 million patients presenting in primary care, the findings provide estimated PPVs that could be used to guide specialist referral decisions, considering the PPVs of common abdominal symptoms for cancer alongside that for IBD and their composite outcome (cancer or IBD), taking into account the variable PPVs of different abdominal symptoms for different cancers sites. Jointly assessing the risk of cancer or IBD can better support decision-making and prompt diagnosis of both conditions, optimising specialist referrals or investigations, particularly in women.
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Affiliation(s)
- Annie Herbert
- MRC Integrative Epidemiology Unit at University of Bristol, Bristol, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Meena Rafiq
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Tra My Pham
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Cristina Renzi
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Gary A. Abel
- University of Exeter Medical School, University of Exeter, Exeter, Devon, United Kingdom
| | - Sarah Price
- University of Exeter Medical School, University of Exeter, Exeter, Devon, United Kingdom
| | - Willie Hamilton
- University of Exeter Medical School, University of Exeter, Exeter, Devon, United Kingdom
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, United Kingdom
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
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12
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Bertels L, Lucassen P, van Asselt K, Dekker E, van Weert H, Knottnerus B. Motives for non-adherence to colonoscopy advice after a positive colorectal cancer screening test result: a qualitative study. Scand J Prim Health Care 2020; 38:487-498. [PMID: 33185121 PMCID: PMC7781896 DOI: 10.1080/02813432.2020.1844391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
SETTING Participants with a positive faecal immunochemical test (FIT) in screening programs for colorectal cancer (CRC) have a high risk for colorectal cancer and advanced adenomas. They are therefore recommended follow-up by colonoscopy. However, more than ten percent of positively screened persons do not adhere to this advice. OBJECTIVE To investigate FIT-positive individuals' motives for non-adherence to colonoscopy advice in the Dutch CRC screening program. SUBJECTS Non-adherent FIT-positive participants of the Dutch CRC screening program. DESIGN We conducted semi structured in-depth interviews with 17 persons who did not undergo colonoscopy within 6 months after a positive FIT. Interviews were undertaken face-to-face and data were analysed thematically with open coding and constant comparison. RESULTS All participants had multifactorial motives for non-adherence. A preference for more personalised care was described with the following themes: aversion against the design of the screening program, expectations of personalised care, emotions associated with experiences of impersonal care and a desire for counselling where options other than colonoscopy could be discussed. Furthermore, intrinsic motives were: having a perception of low risk for CRC (described by all participants), aversion and fear of colonoscopy, distrust, reluctant attitude to the treatment of cancer and cancer fatalism. Extrinsic motives were: having other health issues or priorities, practical barriers, advice from a general practitioner (GP) and financial reasons. CONCLUSION Personalised screening counselling might have helped to improve the interviewees' experiences with the screening program as well as their knowledge on CRC and CRC screening. Future studies should explore whether personalised screening counselling also has potential to increase adherence rates. Key points Participants with a positive FIT in two-step colorectal cancer (CRC) screening programs are at high risk for colorectal cancer and advanced adenomas. Non-adherence after an unfavourable screening result happens in all CRC programs worldwide with the consequence that many of the participants do not undergo colonoscopy for the definitive assessment of the presence of colorectal cancer. Little qualitative research has been done to study the reasons why individuals participate in the first step of the screening but not in the second step. We found a preference for more personalised care, which was not reported in previous literature on this subject. Furthermore, intrinsic factors, such as a low risk perception and distrust, and extrinsic factors, such as the presence of other health issues and GP advice, may also play a role in non-adherence. A person-centred approach in the form of a screening counselling session may be beneficial for this group of CRC screening participants.
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Affiliation(s)
- Lucinda Bertels
- Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- CONTACT Lucinda Bertels , .Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Erasmus School of Health Policy & Management, Rotterdam
| | - Peter Lucassen
- Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Kristel van Asselt
- Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk van Weert
- Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart Knottnerus
- Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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13
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Predictive values of lung cancer alarm symptoms in the general population: a nationwide cohort study. NPJ Prim Care Respir Med 2020; 30:15. [PMID: 32265450 PMCID: PMC7138801 DOI: 10.1038/s41533-020-0173-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
We aimed to firstly determine the 1-year predictive values of lung cancer alarm symptoms in the general population and to analyse the proportion of alarm symptoms reported prior to diagnosis, and secondly analyse how smoking status and reported contact with general practitioners (GPs) regarding lung cancer alarm symptoms influence the predictive values. The study was a nationwide prospective cohort study of 69,060 individuals aged ≥40 years, randomly selected from the Danish population. Using information gathered in a survey regarding symptoms, lifestyle and healthcare-seeking together with registry information on lung cancer diagnoses in the subsequent year, we calculated the predictive values and likelihood ratios of symptoms that might be indicative of lung cancer. Furthermore, we analysed how smoking status and reported contact with GPs regarding the alarm symptoms affected the predictive values. We found that less than half of the patients had reported an alarm symptom six months prior to lung cancer diagnosis. The positive predictive values of the symptoms were generally very low, even for patients reporting GP contact regarding an alarm symptom. The highest predictive values were found for dyspnoea, hoarseness, loss of appetite and for current heavy smokers. The negative predictive values were high, all close to 100%. Given the low positive predictive values, our findings emphasise that diagnostic strategies should not focus on single, specific alarm symptoms, but should perhaps focus on different clusters of symptoms. For patients not experiencing alarm symptoms, the risk of overlooking lung cancer is very low.
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