Abstract
Iron deficiency anaemia (IDA) is common in colorectal cancer (CRC), especially, in right-sided CRC which is known to have an overall worse prognosis. The associations between diagnostic pathway (Bowel Cancer Screening Programme (BCSP), IDA, symptomatic) and tumour side/stage was assessed using logistic regression models in 1138 CRC cases presenting during 2010–2016 at a single secondary-care centre in the UK. In the IDA sub-group, the relationship between CRC stage and the event of having a blood count prior to CRC diagnosis was examined using Bayesian parametric survival model. IDA was found as the only significant predictor of right-sided CRC (OR 10.61, 95% CI 7.02–16.52). Early-stage CRC was associated with both the IDA (OR 1.65, 95% CI 1.18–2.29) and BCSP pathway (OR 2.42, 95% CI 1.75–3.37). At any age, the risk of detecting CRC at late-stage was higher in those without a previous blood count check (hazard ratio 1.53, 95% credibility interval 1.08–2.14). The findings of this retrospective observational study suggest a benefit from diagnosing CRC through the detection of IDA, and warrant further research into the prognosis benefit of systematic approach to blood count monitoring of the at-risk population.
Highlights
Iron deficiency anaemia (IDA) is common in colorectal cancer (CRC), especially, in right-sided CRC which is known to have an overall worse prognosis
Our results demonstrate that during the 7-year study period, just over 30% of CRCs were diagnosed via either the IDA or Bowel Cancer Screening Programme (BCSP) pathway, with similar numbers in each
We have confirmed previous observations that IDA is strongly associated with right-sided CRC, but the striking finding from our study is that diagnosis through a contemporary IDA pathway has the potential to downstage the disease, as previously demonstrated for the BCSP p athway[9]
Summary
Iron deficiency anaemia (IDA) is common in colorectal cancer (CRC), especially, in right-sided CRC which is known to have an overall worse prognosis. The risk of detecting CRC at late-stage was higher in those without a previous blood count check (hazard ratio 1.53, 95% credibility interval 1.08–2.14). Abbreviations CRC Colorectal cancer IDA Iron deficiency anaemia Hb Blood haemoglobin concentration GP General Practitioner BCSP Bowel Cancer Screening Programme OR Odds ratio CI Confidence interval. CRC may not cause symptoms until the disease is already advanced, and when symptoms do develop there is sometimes reluctance to seek medical advice The consequence of these delays is that many cases of CRC present at a late stage, with a correspondingly high mortality rate. The BCSP is based on the biennial offer of a faecal occult blood test to all in the population aged 60–74, with a view to colonoscopy if positive
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