Impact of faecal occult blood test screening on emergency admissions and short-term outcomes for colorectal cancer

Abstract

Background: Small studies have examined the effect of faecal occult blood test (FOBT) screening on the proportion of hospital admissions for colorectal cancer (CRC) classed as an emergency. This study aimed to examine this and short-term outcomes in persons invited for screening compared with a control group not invited. Methods: The invited group comprised all individuals invited between 1 April 2000 and 31 July 2007 in the Scottish arm of the UK demonstration pilot of FOBT, and subsequently diagnosed with CRC aged 50-72 years between 1 May 2000 and 31 July 2009. The controls comprised all remaining individuals in Scotland not invited for FOBT but diagnosed with CRC aged 50-72 years in the same period. Results: There were 2981 people diagnosed with CRC in the group invited for screening (58⋅3 per cent participated) and 9842 in the control group. Multivariable regression adjusted for sex, age, deprivation, co-morbidities, tumour site and Dukes' stage showed no difference between the groups for emergency admissions (odds ratio (OR) 0⋅89, 95 per cent confidence interval (c.i.) 0⋅77 to 1⋅02; P = 0⋅084) or length of hospital stay (LOS) ( coefficient −1⋅02 (95 per cent c.i. -1⋅05 to 1⋅01) days; P = 0⋅226). Comparing participants with controls, there were fewer emergency admissions (OR 0⋅59, 0⋅49 to 0⋅71; P < 0⋅001) and shorter LOS ( coefficient −1⋅06 (−1⋅10 to −1⋅02) days; P = 0⋅001). Short-term mortality was lower in the screened than the non-screened population (1⋅1 versus 2⋅8 per cent; P = 0⋅001). Conclusion: People who participated in FOBT screening had fewer emergency admissions and a shorter LOS. Deprivation was associated negatively with participation, but the impact of FOBT participation on emergency admissions was independent of deprivation level. The reduction in LOS has potential to reduce financial costs.

Temporal trends in mode, site and stage of presentation with the introduction of colorectal cancer screening: a decade of experience from the West of Scotland

“…It therefore questions the impact that screening itself has had on overall emergency presentation in our geographical area. This is in keeping with a recently published cohort study, which has shown that emergency admissions are reduced when comparing participants and non-participants in screening; however, they remain similar comparing cohorts invited and not invited to screening ( Libby et al , 2014 ). Therefore, it appears that it is participation and not invitation that is the key determinant in reducing emergency admissions.…”

Negative Impact of COVID-19 Associated Health System Shutdown on Patients Diagnosed With Colorectal Cancer: A Retrospective Study From a Large Tertiary Center in Ontario, Canada

“…Conversely, screening programs, such as those that were put on hold during the slowdown period, are associated with lower rates of emergent presentation as tumours and pre-cancerous lesions are identified and removed at an earlier stage. ( 12 , 14–16 )…”

Negative impact of COVID-19 associated health system shutdown on patients diagnosed with colorectal cancer: a retrospective study from a large tertiary center in Ontario, Canada

“…Conversely, screening programs, such as those that were put on hold during the slowdown period, are associated with lower rates of emergent presentation as tumours and pre-cancerous lesions are identified and removed at an earlier stage. 12,[14][15][16] According to our data, patients in the post-slowdown cohort had tumours that were on average 25% larger than patients in the pre-slowdown cohort. The reduced number of patients receiving neoadjuvant therapy in the post-shutdown cohort may have marginally contributed to the differences in average tumour size between the two populations; however, the vast majority (78% of patients) did not receive neoadjuvant treatment.…”