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Abstract
Aim: Faecal immunochemical testing (FIT) is used in the detection of colorectal cancer (CRC). FIT is invariably used at a single faecal haemoglobin (f-Hb) concentration threshold. The aim of this observational study was to explore risk scoring models (RSMs) with f-Hb and other risk factors for CRC in symptomatic patients attending primary care, potentially speeding diagnosis and saving endoscopy resources.
Method: Records of patients completing FIT were linked with The Scottish Cancer Registry and with other databases with symptoms, full blood count and demographic variables, and randomized into derivation and validation cohorts. Stepwise multivariable logistic regression created RSMs assessed in the validation cohort.
Results: Of 18 805 unique patients, 9374 and 9431 were in the derivation and validation cohorts, respectively: f-Hb, male sex, increasing age, iron deficiency anaemia and raised systemic immune inflammation index created the final RSM. A risk score threshold of ≥2.363, generating the same number of colonoscopies as a f-Hb threshold of ≥10 μg Hb/g gave improved sensitivity for CRC in both cohorts. A RSM which excluded f-Hb was used to investigate the effect of raising the f-Hb threshold from ≥10 to ≥20 μg Hb/g in those with a low risk score. This approach would have generated 234 fewer colonoscopies but missed four CRCs.
Conclusion: The RSM conferred no significant benefit to patients with very low f-Hb and CRC. Alternative strategies combining FIT with other variables may be more appropriate for safety-netting of symptomatic patients. Further work to develop and investigate the value of RSM for significant bowel disease other than CRC may also be beneficial.
Original language | English |
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Pages (from-to) | 675-683 |
Number of pages | 9 |
Journal | Colorectal Disease |
Volume | 26 |
Issue number | 4 |
Early online date | 29 Feb 2024 |
DOIs | |
Publication status | Published - Apr 2024 |
Keywords
- colorectal cancer
- faecal haemoglobin
- faecal immunochemical test
- primary care
ASJC Scopus subject areas
- Gastroenterology
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Dive into the research topics of 'Do risk scores improve use of faecal immunochemical testing for haemoglobin in symptomatic patients in primary care?'. Together they form a unique fingerprint.Projects
- 1 Finished
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Intelligent Use of Quantitative Faecal Immunochemical Testing for Haemoglobin in Screening and Symptomatic Populations
Fraser, C. (Investigator), Mowat, C. (Investigator) & Steele, B. (Investigator)
1/11/19 → 31/10/21
Project: Research