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Diagnosing colorectal cancer in primary care : cohort study in Sweden of qualitative faecal immunochemical tests, haemoglobin levels, and platelet counts

Högberg, Cecilia ; Gunnarsson, Ulf ; Jansson, Stefan ; Thulesius, Hans LU ; Cronberg, Olof LU orcid and Lilja, Mikael (2020) In British Journal of General Practice 70(701). p.843-851
Abstract

BACKGROUND: Colorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagnostic aids are desired. Qualitative faecal immunochemical tests (FITs) have been used for suspected CRC in Sweden since the mid-2000s, but evidence regarding their effectiveness is scarce. Anaemia and thrombocytosis are both associated with CRC. AIM: To evaluate the usefulness of qualitative FITs requested for symptomatic patients in primary care, alone and combined with findings of anaemia and thrombocytosis, in the diagnosis of CRC. DESIGN AND SETTING: A population-based cohort study using electronic health records and data from the Swedish Cancer Register, covering five Swedish regions. METHOD: Patients aged ≥18 years in the five regions... (More)

BACKGROUND: Colorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagnostic aids are desired. Qualitative faecal immunochemical tests (FITs) have been used for suspected CRC in Sweden since the mid-2000s, but evidence regarding their effectiveness is scarce. Anaemia and thrombocytosis are both associated with CRC. AIM: To evaluate the usefulness of qualitative FITs requested for symptomatic patients in primary care, alone and combined with findings of anaemia and thrombocytosis, in the diagnosis of CRC. DESIGN AND SETTING: A population-based cohort study using electronic health records and data from the Swedish Cancer Register, covering five Swedish regions. METHOD: Patients aged ≥18 years in the five regions who had provided FITs requested by primary care practitioners from 1 January 2015 to 31 December 2015 were identified. FIT and blood-count data were registered and all CRC diagnoses made within 2 years were retrieved. Diagnostic measurements were calculated. RESULTS: In total, 15 789 patients provided FITs (four different brands); of these patients, 304 were later diagnosed with CRC. Haemoglobin levels were available for 13 863 patients, and platelet counts for 10 973 patients. Calculated for the different FIT brands only, the sensitivities for CRC were 81.6%-100%; specificities 65.7%-79.5%; positive predictive values 4.7%-8.1%; and negative predictive values 99.5%-100%. Calculated for the finding of either a positive FIT or anaemia, the sensitivities increased to 88.9-100%. Adding thrombocytosis did not further increase the diagnostic performance. CONCLUSION: Qualitative FITs requested in primary care seem to be useful as rule-in tests for referral when CRC is suspected. A negative FIT and no anaemia indicate a low risk of CRC.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anaemia, colorectal neoplasms, general practice, occult blood, thrombocytosis
in
British Journal of General Practice
volume
70
issue
701
pages
843 - 851
publisher
Royal College of General Practitioners
external identifiers
  • scopus:85096946830
  • pmid:33139332
ISSN
1478-5242
DOI
10.3399/bjgp20X713465
language
English
LU publication?
yes
id
5750ec11-644e-412f-a13b-edbc462a39aa
date added to LUP
2020-12-09 14:06:38
date last changed
2024-03-20 20:51:05
@article{5750ec11-644e-412f-a13b-edbc462a39aa,
  abstract     = {{<p>BACKGROUND: Colorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagnostic aids are desired. Qualitative faecal immunochemical tests (FITs) have been used for suspected CRC in Sweden since the mid-2000s, but evidence regarding their effectiveness is scarce. Anaemia and thrombocytosis are both associated with CRC. AIM: To evaluate the usefulness of qualitative FITs requested for symptomatic patients in primary care, alone and combined with findings of anaemia and thrombocytosis, in the diagnosis of CRC. DESIGN AND SETTING: A population-based cohort study using electronic health records and data from the Swedish Cancer Register, covering five Swedish regions. METHOD: Patients aged ≥18 years in the five regions who had provided FITs requested by primary care practitioners from 1 January 2015 to 31 December 2015 were identified. FIT and blood-count data were registered and all CRC diagnoses made within 2 years were retrieved. Diagnostic measurements were calculated. RESULTS: In total, 15 789 patients provided FITs (four different brands); of these patients, 304 were later diagnosed with CRC. Haemoglobin levels were available for 13 863 patients, and platelet counts for 10 973 patients. Calculated for the different FIT brands only, the sensitivities for CRC were 81.6%-100%; specificities 65.7%-79.5%; positive predictive values 4.7%-8.1%; and negative predictive values 99.5%-100%. Calculated for the finding of either a positive FIT or anaemia, the sensitivities increased to 88.9-100%. Adding thrombocytosis did not further increase the diagnostic performance. CONCLUSION: Qualitative FITs requested in primary care seem to be useful as rule-in tests for referral when CRC is suspected. A negative FIT and no anaemia indicate a low risk of CRC.</p>}},
  author       = {{Högberg, Cecilia and Gunnarsson, Ulf and Jansson, Stefan and Thulesius, Hans and Cronberg, Olof and Lilja, Mikael}},
  issn         = {{1478-5242}},
  keywords     = {{anaemia; colorectal neoplasms; general practice; occult blood; thrombocytosis}},
  language     = {{eng}},
  number       = {{701}},
  pages        = {{843--851}},
  publisher    = {{Royal College of General Practitioners}},
  series       = {{British Journal of General Practice}},
  title        = {{Diagnosing colorectal cancer in primary care : cohort study in Sweden of qualitative faecal immunochemical tests, haemoglobin levels, and platelet counts}},
  url          = {{http://dx.doi.org/10.3399/bjgp20X713465}},
  doi          = {{10.3399/bjgp20X713465}},
  volume       = {{70}},
  year         = {{2020}},
}