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J Med Screen. 2018 Sep;25(3):141-148. doi: 10.1177/0969141317718860. Epub 2017 Sep 1.

Repeated faecal occult blood testing is associated with decreased advanced colorectal cancer risk: A population-based study.

James PD1,2,3, Rabeneck L2,3,4,5,6, Yun L3, Paszat L2,3, Baxter NN2,3,4,7,8, Govindarajan A3,7, Antonova L1, Tinmouth JM2,3,4,9.

Author information

1
1 The Ottawa Health Research Institute and Department of Medicine, University of Ottawa, Ottawa, Canada.
2
2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
3
3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
4
4 Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.
5
7 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
6
8 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
7
5 Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
8
6 Li Ka Shing Research Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
9
9 Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

To evaluate the association between repeated faecal occult blood testing and advanced colorectal cancer risk at population level in Canada.

METHODS:

A retrospective cohort study of all Ontario residents aged 56-74 diagnosed with colorectal cancer from 1 April 2007 to 31 March 2010, identified using health administrative data. The primary outcome was stage IV colorectal cancer, and primary exposure was faecal occult blood testing use within five years prior to colorectal cancer diagnosis. Patients were categorized into four mutually exclusive groups based on their exposure to faecal occult blood testing in the five years prior to colorectal cancer diagnosis: none, pre-diagnostic, repeated, and sporadic. Logistic regression was utilized to adjust for confounders.

RESULTS:

Of 7753 patients (median age 66, interquartile range 61-70, 62% male) identified, 1694 (22%) presented with stage I, 2056 (27%) with stage II, 2428 (31%) with stage III, and 1575 (20%) with stage IV colorectal cancer. There were 4092 (53%) with no record of prior faecal occult blood testing, 1485 (19%) classified as pre-diagnostic, 1693 (22%) as sporadic, and 483 (6%) as repeated faecal occult blood testing. After adjusting for confounders, patients who had repeated faecal occult blood testing were significantly less likely to present with stage IV colorectal cancer at diagnosis (Odds ratio 0.46, 95% Confidence Interval 0.34-0.62) than those with no prior faecal occult blood testing.

CONCLUSIONS:

Repeated faecal occult blood testing is associated with a decreased risk of advanced colorectal cancer. Our findings support the use of organized screening programmes that employ repeated faecal occult blood testing to improve colorectal cancer outcomes at population level.

KEYWORDS:

Faecal occult blood testing; cancer stage; colorectal cancer; faecal occult blood test; screening

PMID:
28862521
DOI:
10.1177/0969141317718860

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