Colorectal Cancer Survival in 50- to 69-Year-Olds after Introducing the Faecal Immunochemical Test

María Angeles Gutierrez-Stampa, Vanessa Aguilar, Cristina Sarasqueta, Joaquín Cubiella, Isabel Portillo, Luis Bujanda, María Angeles Gutierrez-Stampa, Vanessa Aguilar, Cristina Sarasqueta, Joaquín Cubiella, Isabel Portillo, Luis Bujanda

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.

Keywords: colorectal cancer; faecal immunochemical test; survival.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram showing route to diagnosis of colorectal cancer (CRC) in groups 1, 2 and 3.
Figure 2
Figure 2
Kaplan-Meier overall survival curves by group. (Group 1: screen-detected CRC; Group 2: symptomatic patients with positive faecal immunochemical test results in the previous 12 months; Group 3: symptomatic patients who did not undergo faecal immunochemical testing or had a negative FIT result).

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