The Effects of Direct Oral Anticoagulants, Warfarin, Aspirin and Thienopyridine on the Performance of Immunochemical, Faecal, Occult Blood Tests.

AIM: To clarify whether antithrombotic drugs affect diagnosis using the immunochemical faecal occult blood test -(iFOBT) of colorectal neoplasia. METHODS: Using the Japan Endoscopy Database from 8 centres between 2015 and 2017, we analyzed data about patients who were iFOBT positive and had received direct oral anticoagulants (DOAC), warfarin, aspirin or thienopyridine. One-to-one matching-analogue propensity score weighted analyses were performed to compare the positive predictive value (PPV) of all neoplasms, invasive and non-invasive colorectal cancers and adenomas between drug users and non-users. All neoplasms included invasive and non-invasive colorectal cancer, and adenomas. RESULTS: We analyzed 197 DOAC users and 196 non-users, 153 warfarin users and 153 non-users, 408 aspirin users and 415 non-users, and 97 thienopyridine users and 97 non-users. No significant differences were observed in the PPV for all neoplasms (56.67 vs. 50.43%), invasive cancer (4.32 vs. 3.53%), non-invasive cancer (15.58 vs. 15.56%) or adenoma (53.13 vs. 48.09%) between the DOAC user and non-user groups. No significant differences were observed in the PPV for all neoplasia, invasive and non-invasive cancer, or adenoma between warfarin, aspirin and thienopyridine use and non-users. CONCLUSIONS: DOAC, warfarin, aspirin and thienopyridine use did not decrease the PPVs of the iFOBT used to evaluate all colorectal neoplasia.

Psychosocial consequences of receiving false-positive colorectal cancer screening results: a qualitative study.

Objective: The objective of this study was to investigate the psychosocial consequences of receiving false-positive colorectal cancer (CRC) screening results, following a positive immunochemical faecal occult blood test. Design, setting, and subjects: We conducted a qualitative study with four semi-structured focus group interviews with 16 participants aged 50-74, all of whom had received a false-positive result in the national Danish CRC screening programme. We selected, recruited, and grouped participants to ensure maximum variation, and to enable a level of confidence to speak openly about experiences of screening. We subjected interview data, audio-recordings, and transcripts to a strategy of qualitative analysis called systematic text condensation. Results: We identified four main themes which described the psychosocial consequences of false-positive CRC screening results: anxiety; discomfort; changed self-perception and behaviour; and considerations on participation in screening. Each of these themes covered a wide range of experiences which were relevant to the informants and broadly shared by them in many aspects. Conclusions: Receiving false-positive results from CRC screening can lead to negative psychosocial consequences such as changes in self-perception and anxiety: some participants may experience subsequent relief, others not. These negative psychosocial consequences might persist over time. Implications: Negative psychosocial consequences from false-positive CRC screening results may result in a greater use of general practitioner services by healthy people who need reassurance or further tests. More research using condition-specific measures is required to further understand the degree and potential persistence of psychosocial consequences of false-positive results from CRC screening. Key Points Participants who receive false-positive colorectal cancer (CRC) screening results may experience negative psychosocial consequences e.g. anxiety and subsequent relief. Participants who receive false-positive CRC screening results may experience discomfort during the screening process. Participants who receive false-positive CRC screening results may experience longer term changes of self-perception. Participants who receive false-positive CRC screening results may experience ambivalence about the offered diagnostic down-stream procedures including colonoscopy.

Nonsteroidal Anti-Inflammatory Drug-Induced Colopathy in a Colorectal Cancer Screening Program.

OBJECTIVE: To present a case of colopathy related to the use of diclofenac in a patient with a positive immunochemical faecal occult blood test (iFOBT) and to discuss the influence of nonsteroidal anti-inflammatory drugs (NSAIDs) on iFOBT specificity. CLINICAL PRESENTATION AND INTERVENTION: A colonoscopy in a 56-year-old female presenting with a positive iFOBT revealed diaphragm-like strictures and ulcers in the right colon. While carrying out a detailed retrospective interview, she reported a chronic backache requiring long-term NSAID treatment. CONCLUSION: No association has been established between chronic use of NSAID and a false-positive iFOBT. There is no need to stop NSAIDs before performing an iFOBT in a colorectal cancer screening program.

An analysis of the duplicate testing strategy of an Irish immunochemical faecal occult blood test colorectal cancer screening programme.

AIM: This study examined the relevance of using a two-sample quantitative immunochemical faecal occult blood test (FIT) at a high cut-off stringency by the first population-based colorectal cancer (CRC) pilot screening programme in Ireland. METHOD: Approximately 10,000 individuals between the ages of 50 and 74 years were invited to perform two consecutive FITs. These were analysed in tandem using the OC Sensor and participants with at least one positive result with a haemoglobin cut-off for positivity at 100 ng/ml were offered colonoscopy. RESULTS: A total of 5023 (52%) [2177 (43%) male, 2846 (57%) female] individuals with a median age of 64 years participated. At least one positive FIT was detected from 514 (10%) individuals. From the 419 (82%) patients who proceeded to colonoscopy 17 (4%) had CRC and 132 (33%) had an advanced adenoma. The detection rate for these screen-relevant lesions was 3% (95% CI 2.5-3.5) and the FIT-positive colonoscopy detection rate was 36% (95% CI 31-40). The number needed to undergo colonoscopy to find an advanced lesion was 2.8. The two-test system detected four (23.5%) additional patients with CRC and 37 (28%) with an advanced adenoma compared with a single test. CONCLUSION: The CRC miss rate estimated for a single test (23.5%) was unacceptably high when the goal was to maximize the discovery of advanced lesions in the initial screening round. We conclude that the two-test protocol at a high cut-off threshold is suitable for optimizing FIT screening in Ireland.

Switching from guaiac to immunochemical faecal occult blood test increases participation and diagnostic yield of colorectal cancer screening.

BACKGROUND: Compared with the guaiac-faecal occult blood test (gFOBT), faecal immunological tests (FIT) are considered to be more effective for colorectal cancer (CRC) screening. However, only scarce research has examined the outcomes of switching to FIT within a mature gFOBT-based CRC screening programme. METHODS: We reported a 15-year experience of biennial FOBT screening in a well-defined population of approximately one million inhabitants, including six gFOBT-based screening rounds and one round with FIT at the 30 µg Hb/g cut-off. The main outcome measures were screening participation, FOBT positivity and advanced neoplasia detection in each round. RESULTS: In this study, 647 676 screenings were performed in 228 716 different individuals, leading to 17 819 positives and 16 580 follow-up colonoscopies. Compared with the last gFOBT round, switching to FIT led to an increased participation of nearly 20% points, and a fivefold increased detection of CRC and advanced adenoma among invitees (3-fold among attendees). The numbers needed to screen and scope to detect one advanced neoplasia declined from 221 to 66 and from 4.7 to 2.6, respectively. CONCLUSIONS: The present population-based study demonstrated a dramatical increase in the diagnostic yield of advanced neoplasia by switching to FIT within a mature gFOBT-based CRC screening programme.

The Effect of Educational Intervention on the Patient's Willingness to Carry out the Immunochemical Faecal Occult Blood Test for Colorectal Cancer.

BACKGROUND: There is now compelling evidence that screening for colorectal cancer may result in significantly reduced mortality. Screening tests for colorectal cancer are not systematically performed in Bulgaria. AIM: This article explores the effect of an educational intervention on the willingness of patients to participate in the screening for colorectal cancer with the immunochemical faecal occult blood test in the home setting. MATERIALS AND METHODS: A before-after design study of the effects of educational intervention comprising distribution of a brochure and one-to-one discussion with a GP. A self-administered, original questionnaire was administered before and after the intervention to 600 randomly selected patients in 40 general practices (15 patients per practice) in Plovdiv district. RESULTS: The intervention led to an increase with >20% of the patient's knowledge of the importance of the test and on how to carry out the test. Statistical analysis indicated that there was an increase in knowledge after the educational intervention about the usefulness of the test (24.8% in males, 18.3% in females) and its performance (22.7% in males, 25.4% in females). CONCLUSION: The educational intervention has significantly influenced the patient's awareness about the test's usefulness and its self-administration. It improved the awareness by providing an easy access to information, thus fostering the active involvement of the patients. A strength of the intervention was the patient-centered approach in providing additional information through one-to-one discussions, and it ensured a higher quality of the preventive screening in the general practice.

Characteristics of colorectal tumours in asymptomatic patients with negative immunochemical faecal occult blood test results.

The immunochemical faecal occult blood test (iFOBT) is a simple, non-invasive colorectal cancer (CRC) screening method for reducing CRC-related mortality. However, the sensitivity of iFOBT is imperfect and certain colonic neoplasms that require removal may be missed. The aim of this study was to investigate the incidence and characteristics of CRC in asymptomatic, iFOBT-negative patients who underwent opportunistic screening. A total of 919 subclinical patients (276 iFOBT-positive and 643 iFOBT-negative) in the health screening program of our hospital underwent total colonoscopy (TCS) within 2 years after iFOBT. The patients were divided into an iFOBT-positive and an iFOBT-negative group and the TCS findings were compared between the two groups. Although the incidence of advanced neoplasia (CRC, high-grade dysplasia, adenoma sized ≥10 mm and tubulovillous adenoma) was significantly higher in the iFOBT-positive group, these lesions were also found in 6.3% of iFOBT-negative patients. The lesions tended to be proximally located and non-protruding. In conclusion, screening with iFOBT remains clinically significant. However, colonoscopy is indispensable for reducing the incidence and mortality of CRC.