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Sex is a stronger predictor of colorectal adenoma and advanced adenoma than fecal occult blood test

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Abstract

Due to high costs and limited availability of screening colonoscopy, some screening programs require a positive fecal occult blood test (FOBT) before screening colonoscopy is remunerated. As male sex is a strong predictor of adenoma and advanced adenoma, we evaluated whether a positive FOBT or male sex is a stronger risk factor for adenoma and advanced adenoma. FOBT and screening colonoscopy results from 18.665 consecutive patients participating in a “national health check program” between 2009 and 2011 were included in this cohort study. Age-corrected adenoma detection rates (ADR), advanced adenoma detection rates (AADR) and carcinoma detection rates were calculated for men and women according to FOBT result separately. ADR and AADR in FOBT-positive men (34.6 and 11.8 %) and FOBT-negative men (29.1 and 7.6 %) were higher than ADR and AADR in FOBT-positive women (20 and 6.9 %) and in FOBT-negative women (17.6 and 4.4 %), (p = 0.0003). Men with negative FOBT were at higher risk of having an adenoma and advanced adenoma than women with positive FOBT (p < 0.0001). Odds ratios of a positive FOBT for ADR and AADR were 1.3 (1.1–1.5) (p = 0.0047) and 1.6 (1.2–2.1) (p < 0.0001), respectively. Odds ratios of male sex to predict ADR and AADR were significantly higher with 1.9 (1.8–2.1) and 1.8 (1.6–2), respectively (p < 0.001). Male sex is a stronger predictor for colorectal adenoma and advanced adenoma than positive FOBT. These results should be taken into account analyzing FOBT-based screening programs.

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References

  1. Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687–96.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  2. Lebwohl B, Capiak K, Neugut AI, Kastrinos F. Risk of colorectal adenomas and advanced neoplasia in Hispanic, black and white patients undergoing screening colonoscopy. Aliment Pharmacol Ther. 2012;35(12):1467–73.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  3. Gupta S, Saunders BP, Fraser C, Kennedy RH, Ignjatovic A, Sala S, et al. The first 3 years of national bowel cancer screening at a single UK tertiary centre. Colorectal Dis. 2012;14(2):166–73.

    Article  PubMed  CAS  Google Scholar 

  4. http://www.cancerscreening.nhs.uk/bowel/publications/bowel-cancer-the-facts.pdf

  5. Klabunde CN, Lanier D, Nadel MR, McLeod C, Yuan G, Vernon SW. Colorectal cancer screening by primary care physicians: recommendations and practices, 2006–2007. Am J Prev Med. 2009;37(1):8–16.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hundt S, Haug U, Brenner H. Comparative evaluation of immunochemical fecal occult blood tests for colorectal adenoma detection. Ann Intern Med. 2009;150(3):162–9.

    Article  PubMed  Google Scholar 

  7. Morikawa T, Kato J, Yamaji Y, Wada R, Mitsushima T, Shiratori Y. A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology. 2005;129(2):422–8.

    Article  PubMed  Google Scholar 

  8. Levi Z, Rozen P, Hazazi R, Vilkin A, Waked A, Maoz E, et al. A quantitative immunochemical fecal occult blood test for colorectal neoplasia. Ann Intern Med. 2007;146(4):244–55.

    Article  PubMed  Google Scholar 

  9. Haug U, Hundt S, Brenner H. Quantitative immunochemical fecal occult blood testing for colorectal adenoma detection: evaluation in the target population of screening and comparison with qualitative tests. Am J Gastroenterol. 2010;105(3):682–90.

    Article  PubMed  Google Scholar 

  10. Shaukat A, Mongin SJ, Geisser MS, Lederle FA, Bond JH, Mandel JS, et al. Long-term mortality after screening for colorectal cancer. N Engl J Med. 2013;369(12):1106–14.

    Article  PubMed  CAS  Google Scholar 

  11. Ferlitsch M, Reinhart K, Pramhas S, Wiener C, Gal O, Bannert C, et al. Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA. 2011;306(12):1352–8.

    Article  PubMed  CAS  Google Scholar 

  12. Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006;355(18):1863–72.

    Article  PubMed  CAS  Google Scholar 

  13. Hoffmeister M, Schmitz S, Karmrodt E, Stegmaier C, Haug U, Arndt V, et al. Male sex and smoking have a larger impact on the prevalence of colorectal neoplasia than family history of colorectal cancer. Clin Gastroenterol Hepatol. 2010;8(10):870–6.

    Article  PubMed  Google Scholar 

  14. Hassan C, Pickhardt PJ, Kim DH, Di Giulio E, Zullo A, Laghi A, et al. Systematic review: distribution of advanced neoplasia according to polyp size at screening colonoscopy. Aliment Pharmacol Ther. 2010;31(2):210–7.

    PubMed  CAS  Google Scholar 

  15. Royston PAD. Regression using fractional polynomials of continuous covariates: parsimonious parametric modeling. Appl Stat. 1994;43(3):429–67.

    Article  Google Scholar 

  16. Ambler GBA. The mfp package. Vienna: R Foundation for Statistical Computing; 2010.

    Google Scholar 

  17. Haug U, Kuntz KM, Knudsen AB, Hundt S, Brenner H. Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia. Br J Cancer. 2011;104(11):1779–85.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Steele RJ, McClements PL, Libby G, Black R, Morton C, Birrell J, et al. Results from the first three rounds of the Scottish demonstration pilot of FOBT screening for colorectal cancer. Gut. 2009;58(4):530–5.

    Article  PubMed  CAS  Google Scholar 

  19. Kolligs FT, Crispin A, Munte A, Wagner A, Mansmann U, Goke B. Risk of advanced colorectal neoplasia according to age and gender. PLoS One. 2011;6(5):e20076.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  20. Lieberman DA, Prindiville S, Weiss DG, Willett W. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA. 2003;290(22):2959–67.

    Article  PubMed  Google Scholar 

  21. Ng SC, Ching JY, Chan V, Wong MC, Suen BY, Hirai HW, et al. Diagnostic accuracy of faecal immunochemical test for screening individuals with a family history of colorectal cancer. Aliment Pharmacol Ther. 2013;38(7):835–41.

    Article  PubMed  CAS  Google Scholar 

  22. Rozen P, Levi Z, Hazazi R, Waked A, Vilkin A, Maoz E, et al. Quantitative colonoscopic evaluation of relative efficiencies of an immunochemical faecal occult blood test and a sensitive guaiac test for detecting significant colorectal neoplasms. Aliment Pharmacol Ther. 2009;29(4):450–7.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We would like to thank all participants of the project for their support and data input. A list of contributing endoscopists is available online at www.vorsorgekoloskopie.at and www.krebshilfe.net. We would like to thank Josef Probst, PhD from Austrian Federation of the Statutory Insurance Institutions, Vienna, Austria, for his support in the organization. The project “Quality certificate for screening colonoscopy” was conducted in cooperation with the Main Association of Austrian Social Security Institutions and funded by fund § 447h ASVG (Fund for preventive checkups and health promotion).

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Authors and Affiliations

  1. Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Freyung 6, 1010, Vienna, Austria

    Monika Ferlitsch, Petra Salzl, Martha Britto-Arias, Elisabeth Waldmann, Karoline Reinhart, Christina Bannert, Peter Knoflach, Werner Weiss, Michael Trauner & Arnulf Ferlitsch

  2. Div of Gastroenterology and Hepatology, Internal Medicine III, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Monika Ferlitsch, Petra Salzl, Martha Britto-Arias, Elisabeth Waldmann, Karoline Reinhart, Christina Bannert, Michael Trauner & Arnulf Ferlitsch

  3. Div of Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Georg Heinze

  4. Main Association of Austrian Social Insurance Institutions, Vienna, Austria

    Elisabeth Fasching

Authors
  1. Monika Ferlitsch
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  2. Georg Heinze
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  3. Petra Salzl
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  6. Karoline Reinhart
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  7. Christina Bannert
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  8. Elisabeth Fasching
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  9. Peter Knoflach
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  10. Werner Weiss
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  11. Michael Trauner
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  12. Arnulf Ferlitsch
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Correspondence to Monika Ferlitsch.

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Ferlitsch, M., Heinze, G., Salzl, P. et al. Sex is a stronger predictor of colorectal adenoma and advanced adenoma than fecal occult blood test. Med Oncol 31, 151 (2014). https://doi.org/10.1007/s12032-014-0151-0

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