Biology and Clinical Implications of Fecal Occult Blood Test Screen-Detected Colorectal Cancer
- Author(s)
- Mendis, S; Hong, W; Ananda, S; Faragher, I; Jones, I; Croxford, M; Steel, M; Jalali, A; Gard, G; To, YH; Lee, M; Kosmider, S; Wong, R; Tie, J; Gibbs, P;
- Details
- Publication Year 2022-02,Volume 6,Issue #1,Page pkab100
- Journal Title
- JNCI Cancer Spectrum
- Publication Type
- Research article
- Abstract
- BACKGROUND: Fecal occult blood test (FOBT)-based screening for colorectal cancer (CRC) reduces mortality, with earlier stage at diagnosis a prominent feature. Other characteristics of FOBT screen-detected cancers and any implications for clinical management have not been well explored. METHODS: We examined a multisite clinical registry to compare the characteristics and outcomes of FOBT screen-detected CRC via the Australian National Bowel Cancer Screening Program (NBCSP), which is offered biennially to individuals aged 50-74 years, and age-matched non-screen-detected CRC in the same registry. All statistical tests were 2-sided. Odds ratios (ORs) were calculated using the Baptista-Pike method, and hazard ratios via the log-rank method. RESULTS: Of 7153 registry patients diagnosed June 1, 2006, to June 30, 2020, 4142 (57.9%) were aged between 50 and 74 years. Excluding 406 patients with non-NBCSP screen-detected cancers and 35 patients with unknown method of detection, 473 (12.8%) were screen detected via the NBCSP, and 3228 (87.2%) were non-screen detected. Screen-detected patients were younger (mean age = 62.4 vs 64.2 years; P < .001) and more medically fit (OR for ASA score 1-2 = 1.91, 95% confidence interval [CI] = 1.51 to 2.41; P < .001). Pathologic characteristics within each stage favored the screen-detected patients. Stage III screen-detected colon cancers were more likely to receive adjuvant therapy (OR = 3.58, 95% CI = 1.52 to 8.36; P = .002). Screen-detected patients had superior relapse-free (hazard ratio = 0.41, 95% CI = 0.29 to 0.60; P < .001) and overall survival (hazard ratio = 0.22, 95% CI = 0.15 to 0.35; P < .001), which was maintained in matched stage comparisons and multivariable analysis. CONCLUSIONS: Beyond stage at diagnosis, multiple other factors associated with a favorable outcome are observed in FOBT screen-detected CRC. Given the substantial stage-by-stage differences in survival outcomes, if independently confirmed, individualized adjuvant therapy and surveillance strategies could be warranted for FOBT screen-detected cancers.
- Keywords
- Australia/epidemiology; Biology; *Colonic Neoplasms; *Colorectal Neoplasms/diagnosis; Early Detection of Cancer/methods; Humans; Neoplasm Recurrence, Local; Occult Blood
- Department(s)
- Medical Oncology
- PubMed ID
- 35699496
- Publisher's Version
- https://doi.org/10.1093/jncics/pkab100
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2025-01-31 07:02:47
Last Modified: 2025-01-31 07:03:46