Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal ble
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ORIGINAL ARTICLE
Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal bleeding in primary care: a cohort study Cecilia Högberg 1
&
Ulf Gunnarsson 2 & Olof Cronberg 3,4 & Hans Thulesius 3,4,5 & Mikael Lilja 1 & Stefan Jansson 6
Accepted: 10 June 2020 # The Author(s) 2020
Abstract Background Rectal bleeding is considered an alarm symptom for colorectal cancer (CRC) but it is common and mostly caused by benign conditions. Qualitative faecal immunochemical tests (FITs) for occult blood have been used as diagnostic aids for many years in Sweden when CRC is suspected. The study aimed to evaluate the usefulness of FITs requested by primary care physicians for patients with and without histories of rectal bleeding, in the diagnosis of CRC. Methods Results of all FITs requested in primary care for symptomatic patients in the Örebro region during 2015 were retrieved. Data on each patient’s history of rectal bleeding was gathered from electronic health records. Patients diagnosed with CRC within 2 years were identified from the Swedish Cancer Register. The analysis focused on three-sample FITs, the customary FIT in Sweden. Results A total of 4232 patients provided three-sample FITs. Information about the presence/absence of rectal bleeding was available for 2027 patients, of which 59 were diagnosed with CRC. For 606 patients with the presence of rectal bleeding, the FIT showed sensitivity 96.2%, specificity 60.2%, positive predictive value 9.8% (95% CI 6.1–13.4) and negative predictive value 99.7% (95% CI 99.2–100) for CRC. For 1421 patients without rectal bleeding, the corresponding figures were 100%, 73.6%, 8.3% (95% CI 5.6–10.9) and 100% (95% CI 99.6–100). Conclusion The diagnostic performance of a qualitative three-sample FIT provided by symptomatic patients in primary care was similar for those with and without a history of rectal bleeding. FITs seem useful for prioritising patients also with rectal bleeding for further investigation. Keywords Colorectal neoplasms . Occult blood . Faecal immunochemical tests . Primary health care . Rectal bleeding
Background * Cecilia Högberg [email protected] 1
Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, Umeå Sweden
2
Department of Surgical and Perioperative Sciences, Umeå University, Umeå Sweden
3
Department of Clinical Sciences, Lund University, Malmö Sweden
4
Department of R & D, Region Kronoberg, Växjö Sweden
5
Department of Medicine and Optometry, Linnaeus University, Kalmar Sweden
6
School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro Sweden
Colorectal cancer (CRC) is the third most common cancer worldwide with over 1.8 million new cases registered in 2018 [1]. The majority of symptomatic patients diagnosed with CRC initially consult primary care [2]. Rectal bleeding is associated with CRC and is considered an alarm symptom [3]. It is also a common symptom in the general popula
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