Abstract
Population screening has improved early diagnosis of colorectal cancer (CRC). Nonetheless, most cases are diagnosed in symptomatic patients. Faecal immunochemical testing has been recommended for assessing patients with lower gastrointestinal symptoms, but whether it improves patient survival is unknown. Our objective was to compare CRC survival in 50- to 69-year-olds between asymptomatic screen-detected patients and symptomatic patients by route to diagnosis. Methods: We identified all cases of CRC diagnosed in 50-to 69-year-olds between 2009 and 2016, in Donostialdea (Gipuzkoa, Spain). Three groups were created: 1-screen-detected CRC; 2-CRC detected in symptomatic patients after a positive faecal immunochemical test(FIT); and 3-CRC detected in symptomatic patients without a FIT or after a negative result. We analysed survival using the Kaplan-Meier method and log-rank tests. Results: Of 930 patients diagnosed with CRC, 433 cases were detected through screening and 497 in symptomatic patients, 7.9% after a positive FIT and 45.5% by other means. The 3-year CRC survival was significantly lower in group 3 (69.5%) than groups 1 (93%; p = 0.007) or 2 (87.5%; p = 0.02). The risk of death was lower in groups 1 (HR 0.42, 95% CI 0.30–0.58) and 2 (HR 0.51; 95% CI 0.29–0.87). Conclusion: Half of CRC cases in 50- to 69-year-olds are diagnosed outside screening. Use of the FIT as a diagnostic strategy in symptomatic patients may improve survival.
Highlights
Colorectal cancer (CRC) is the third most common malignant cancer in Europe, when combining both sexes, and the second leading cause of cancer-related death in Spain [1]
This study analyses survival of colorectal cancer (CRC) patients aged between 50–69 years by route to diagnosis and shows a higher survival rate in patients diagnosed after faecal immunochemical testing, both performed as part of the population screening programme and requested for individuals who seek medical attention for symptoms
We found that the 5-year CRC survival differs by route to diagnosis
Summary
Colorectal cancer (CRC) is the third most common malignant cancer in Europe, when combining both sexes, and the second leading cause of cancer-related death in Spain [1]. Tumour stage at diagnosis is the best predictor of survival. For this reason, all efforts must be directed towards achieving a diagnosis in the early-stages, either through population-based screening programmes or prompt diagnosis in symptomatic patients. The implementation of population screening programmes has helped achieve early diagnosis of CRC and reduced CRC-related mortality [2,3] by 18–57% depending on the type of test used [4]. Despite the implementation of such programmes, most CRC cases are still diagnosed in symptomatic patients [7,8]. Symptoms have low positive predictive value for CRC (3–4%), and are not very useful for diagnosing this type of cancer
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