Biomaterial Database

Diagnosing colorectal cancer and inflammatory bowel disease in primary care: The usefulness of tests for faecal haemoglobin, faecal calprotectin, anaemia and iron deficiency. A prospective study. 2017

Cecilia Högberg, and Pontus Karling, and Jörgen Rutegård, and Mikael Lilja

a Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund Hospital , Umeå University , Östersund , Sweden.

OBJECTIVE Abdominal complaints are common reasons to consult primary care but they are seldom caused by colorectal cancer (CRC), high-risk adenomas (HRAs), or inflammatory bowel disease (IBD). Reliable diagnostic aids would be helpful in deciding which patients to refer for bowel imaging. Our aim was to assess the value of a faecal immunochemical test (FIT) and a faecal calprotectin (FC) test in detecting CRC, HRAs and IBD in primary care, and the value of combining these tests with anaemia and iron-deficiency tests. METHODS This prospective study included 373 consecutive patients that received a FIT or a FC test ordered by a primary care physician. We collected samples for FITs, FC tests, full blood counts and iron-deficiency tests. Physicians were instructed to refer patients with a positive FIT or FC test (cut-off ≥100μg/g) for bowel imaging. The patients' presenting symptoms were recorded. Patients were followed for 2 years. RESULTS The best test for detecting CRC and IBD was the combination of the FIT and haemoglobin concentration. This test had a sensitivity, specificity, positive predictive value and negative predictive value of 100%, 61.7%, 11.7% and 100%, respectively. The FIT detected a significantly larger proportion of CRC, HRAs and IBD than the FC test (0.92 versus 0.46, 95% confidence interval 0.22-0.67). CONCLUSIONS A negative FIT combined with a normal haemoglobin concentration could rule out CRC and IBD with a high degree of safety. This could be useful in prioritising referrals for bowel imaging from primary care.

UI	MeSH Term	Description	Entries
D007501	Iron	A metallic element with atomic symbol Fe, atomic number 26, and atomic weight 55.85. It is an essential constituent of HEMOGLOBINS; CYTOCHROMES; and IRON-BINDING PROTEINS. It plays a role in cellular redox reactions and in the transport of OXYGEN.	Iron-56,Iron 56
D008297	Male		Males
D008403	Mass Screening	Organized periodic procedures performed on large groups of people for the purpose of detecting disease.	Screening,Mass Screenings,Screening, Mass,Screenings,Screenings, Mass
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D009780	Occult Blood	Chemical, spectroscopic, or microscopic detection of extremely small amounts of blood.	Fecal Occult Blood Test,Blood, Occult
D011320	Primary Health Care	Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)	Primary Care,Primary Healthcare,Care, Primary,Care, Primary Health,Health Care, Primary,Healthcare, Primary
D011446	Prospective Studies	Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.	Prospective Study,Studies, Prospective,Study, Prospective
D003113	Colonoscopy	Endoscopic examination, therapy or surgery of the luminal surface of the colon.	Colonoscopic Surgical Procedures,Surgical Procedures, Colonoscopic,Colonoscopic Surgery,Surgery, Colonoscopic,Colonoscopic Surgeries,Colonoscopic Surgical Procedure,Colonoscopies,Procedure, Colonoscopic Surgical,Procedures, Colonoscopic Surgical,Surgeries, Colonoscopic,Surgical Procedure, Colonoscopic
D005243	Feces	Excrement from the INTESTINES, containing unabsorbed solids, waste products, secretions, and BACTERIA of the DIGESTIVE SYSTEM.
D005260	Female		Females