Association of ten gastrointestinal and other medical conditions with positivity to faecal occult blood testing in routine screening: a large prospective study of women in England

Emily He (Lead / Corresponding author), Rupert Alison, Roger Blanks, Kirstin Pirie, Gillian Reeves, Robyn L Ward, Robert Steele, Julietta Patnick, Karen Canfell, Valerie Beral, Jane Green

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Abstract

Background: In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60-69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding.

Methods: By electronically linking BCSP and Million Women Study records, we identified 604 495 women without previous colorectal cancer who participated in their first routine FOBt screening between 2006 and 2012. Regression models, using linked national hospital admission records, yielded adjusted relative risks (RRs) in FOBt-positive versus FOBt-negative women for colorectal cancer, adenoma, diverticular disease, inflammatory bowel disease, haemorrhoids, upper gastrointestinal cancer, oesophagitis, peptic ulcer, anaemia and other haematological disorders.

Findings: RRs in FOBt-positive versus FOBt-negative women were 201.3 (95% CI 173.8-233.2) for colorectal cancer and 197.9 (95% CI 180.6-216.8) for adenoma within 12 months after screening and 3.49 (95% CI 2.31-5.26) and 4.88 (95% CI 3.80-6.26), respectively, 12-24 months after screening; P < 0.001 for all RRs. In the 12 months after screening, the RR for inflammatory bowel disease was 26.3 (95% CI 19.9-34.7), and ranged between 2 and 5 for the upper gastrointestinal or haematological disorders. The RRs of being diagnosed with any of the eight conditions other than colorectal neoplasms before screening, and in the 12-24 months after screening, were 1.81 (95% CI 1.81-2.01) and 1.92 (95% CI 1.66-2.13), respectively.

Conclusions: Whereas FOBt positivity is associated with a substantially increased risk of colorectal neoplasms after screening, eight other gastrointestinal and haematological conditions are also associated with FOBt positivity, both before and after screening.

Original languageEnglish
Number of pages10
JournalInternational Journal of Epidemiology
Early online date21 Jan 2019
DOIs
Publication statusE-pub ahead of print - 21 Jan 2019

Fingerprint

Occult Blood
England
Prospective Studies
Colorectal Neoplasms
Inflammatory Bowel Diseases
Early Detection of Cancer
Adenoma
Colonic Neoplasms
Hemorrhoids
Gastrointestinal Neoplasms
Esophagitis
Hospital Records
Peptic Ulcer
Anemia
Hemorrhage

Keywords

  • Bowel cancer screening
  • faecal occult blood test
  • bowel cancer
  • colonoscopy
  • upper gastrointestinal bleeding

Cite this

He, Emily ; Alison, Rupert ; Blanks, Roger ; Pirie, Kirstin ; Reeves, Gillian ; Ward, Robyn L ; Steele, Robert ; Patnick, Julietta ; Canfell, Karen ; Beral, Valerie ; Green, Jane. / Association of ten gastrointestinal and other medical conditions with positivity to faecal occult blood testing in routine screening : a large prospective study of women in England. In: International Journal of Epidemiology. 2019.
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abstract = "Background: In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60-69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding.Methods: By electronically linking BCSP and Million Women Study records, we identified 604 495 women without previous colorectal cancer who participated in their first routine FOBt screening between 2006 and 2012. Regression models, using linked national hospital admission records, yielded adjusted relative risks (RRs) in FOBt-positive versus FOBt-negative women for colorectal cancer, adenoma, diverticular disease, inflammatory bowel disease, haemorrhoids, upper gastrointestinal cancer, oesophagitis, peptic ulcer, anaemia and other haematological disorders.Findings: RRs in FOBt-positive versus FOBt-negative women were 201.3 (95{\%} CI 173.8-233.2) for colorectal cancer and 197.9 (95{\%} CI 180.6-216.8) for adenoma within 12 months after screening and 3.49 (95{\%} CI 2.31-5.26) and 4.88 (95{\%} CI 3.80-6.26), respectively, 12-24 months after screening; P < 0.001 for all RRs. In the 12 months after screening, the RR for inflammatory bowel disease was 26.3 (95{\%} CI 19.9-34.7), and ranged between 2 and 5 for the upper gastrointestinal or haematological disorders. The RRs of being diagnosed with any of the eight conditions other than colorectal neoplasms before screening, and in the 12-24 months after screening, were 1.81 (95{\%} CI 1.81-2.01) and 1.92 (95{\%} CI 1.66-2.13), respectively.Conclusions: Whereas FOBt positivity is associated with a substantially increased risk of colorectal neoplasms after screening, eight other gastrointestinal and haematological conditions are also associated with FOBt positivity, both before and after screening.",
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Association of ten gastrointestinal and other medical conditions with positivity to faecal occult blood testing in routine screening : a large prospective study of women in England. / He, Emily (Lead / Corresponding author); Alison, Rupert; Blanks, Roger; Pirie, Kirstin; Reeves, Gillian; Ward, Robyn L; Steele, Robert; Patnick, Julietta; Canfell, Karen; Beral, Valerie; Green, Jane.

In: International Journal of Epidemiology, 21.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of ten gastrointestinal and other medical conditions with positivity to faecal occult blood testing in routine screening

T2 - a large prospective study of women in England

AU - He, Emily

AU - Alison, Rupert

AU - Blanks, Roger

AU - Pirie, Kirstin

AU - Reeves, Gillian

AU - Ward, Robyn L

AU - Steele, Robert

AU - Patnick, Julietta

AU - Canfell, Karen

AU - Beral, Valerie

AU - Green, Jane

PY - 2019/1/21

Y1 - 2019/1/21

N2 - Background: In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60-69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding.Methods: By electronically linking BCSP and Million Women Study records, we identified 604 495 women without previous colorectal cancer who participated in their first routine FOBt screening between 2006 and 2012. Regression models, using linked national hospital admission records, yielded adjusted relative risks (RRs) in FOBt-positive versus FOBt-negative women for colorectal cancer, adenoma, diverticular disease, inflammatory bowel disease, haemorrhoids, upper gastrointestinal cancer, oesophagitis, peptic ulcer, anaemia and other haematological disorders.Findings: RRs in FOBt-positive versus FOBt-negative women were 201.3 (95% CI 173.8-233.2) for colorectal cancer and 197.9 (95% CI 180.6-216.8) for adenoma within 12 months after screening and 3.49 (95% CI 2.31-5.26) and 4.88 (95% CI 3.80-6.26), respectively, 12-24 months after screening; P < 0.001 for all RRs. In the 12 months after screening, the RR for inflammatory bowel disease was 26.3 (95% CI 19.9-34.7), and ranged between 2 and 5 for the upper gastrointestinal or haematological disorders. The RRs of being diagnosed with any of the eight conditions other than colorectal neoplasms before screening, and in the 12-24 months after screening, were 1.81 (95% CI 1.81-2.01) and 1.92 (95% CI 1.66-2.13), respectively.Conclusions: Whereas FOBt positivity is associated with a substantially increased risk of colorectal neoplasms after screening, eight other gastrointestinal and haematological conditions are also associated with FOBt positivity, both before and after screening.

AB - Background: In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60-69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding.Methods: By electronically linking BCSP and Million Women Study records, we identified 604 495 women without previous colorectal cancer who participated in their first routine FOBt screening between 2006 and 2012. Regression models, using linked national hospital admission records, yielded adjusted relative risks (RRs) in FOBt-positive versus FOBt-negative women for colorectal cancer, adenoma, diverticular disease, inflammatory bowel disease, haemorrhoids, upper gastrointestinal cancer, oesophagitis, peptic ulcer, anaemia and other haematological disorders.Findings: RRs in FOBt-positive versus FOBt-negative women were 201.3 (95% CI 173.8-233.2) for colorectal cancer and 197.9 (95% CI 180.6-216.8) for adenoma within 12 months after screening and 3.49 (95% CI 2.31-5.26) and 4.88 (95% CI 3.80-6.26), respectively, 12-24 months after screening; P < 0.001 for all RRs. In the 12 months after screening, the RR for inflammatory bowel disease was 26.3 (95% CI 19.9-34.7), and ranged between 2 and 5 for the upper gastrointestinal or haematological disorders. The RRs of being diagnosed with any of the eight conditions other than colorectal neoplasms before screening, and in the 12-24 months after screening, were 1.81 (95% CI 1.81-2.01) and 1.92 (95% CI 1.66-2.13), respectively.Conclusions: Whereas FOBt positivity is associated with a substantially increased risk of colorectal neoplasms after screening, eight other gastrointestinal and haematological conditions are also associated with FOBt positivity, both before and after screening.

KW - Bowel cancer screening

KW - faecal occult blood test

KW - bowel cancer

KW - colonoscopy

KW - upper gastrointestinal bleeding

U2 - 10.1093/ije/dyy271

DO - 10.1093/ije/dyy271

M3 - Article

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

SN - 0300-5771

ER -