Aspirin Users Attending for NHS Bowel Cancer Screening Have Less Colorectal Neoplasia: Chemoprevention or False-Positive Faecal Occult Blood Testing?

Lee, Ta‐Jen; Hull, MA; Rajasekhar, PT; Clifford, GM; Ritchie, Marianne; James, P. W.; McNally, Richard J.Q.; Rutter,; Rees, CJ

doi:10.1159/000334372

Cited by 15 publications

(15 citation statements)

References 14 publications

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“…The role of medications which affect hormone levels (e.g., HRT) is unknown and may benefit from further analysis. Similarly, although aspirin use has been shown to be associated with a lower neoplasia detection rate in patients with a positive FOBt, its effect on the positivity of the FOBt in those with a CRC has not been established (Lee et al , 2012b). …”

Section: Discussionmentioning

confidence: 99%

Comparison of screen-detected and interval colorectal cancers in the Bowel Cancer Screening Programme

Gill

Rees

et al. 2012

Br J Cancer

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Background:The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood testing (FOBt) followed by colonoscopy after positive results. Colorectal cancers (CRCs) registered with the Northern Colorectal Cancer Audit Group database were cross-referenced with the BCSP database to analyse their screening history.Methods:The CRCs in the screening population between April 2007 and March 2010 were identified and classified into four groups: control (diagnosed before first screening invite), screen-detected, interval (diagnosed between screening rounds after a negative FOBt), and non-uptake (declined screening). Patient demographics, tumour characteristics and survival were compared between groups.Results:In all, 511 out of 1336 (38.2%) CRCs were controls; 825 (61.8%) were in individuals invited for screening of which 322 (39.0%) were screen detected, 311 (37.7%) were in the non-uptake group, and 192 (23.3%) were interval cancers. Compared with the control and interval cancer group, the screen-detected group had a higher proportion of men (P=0.002, P=0.003 respectively), left colon tumours (P=0.007, P=0.003), and superior survival (both P<0.001). There was no difference in demographics, tumour location/stage, or survival between control and interval groups.Conclusion:The FOBt is better at detecting cancers in the left colon and in men. The significant numbers of interval cancers weren't found to have an improved outcome compared with the non-screened population.

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Section: Discussionmentioning

confidence: 99%

Comparison of screen-detected and interval colorectal cancers in the Bowel Cancer Screening Programme

Gill

Rees

et al. 2012

Br J Cancer

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“…Finally, data on medication use, such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), and anticoagulant, which could be possible confounders, were not available. These drugs could increase the risk of bleeding from non-neoplastic lesions and cause FP FIT results 828. In addition, the use of aspirin or NSAID could be related with the risk of CRN development.…”

Section: Discussionmentioning

confidence: 99%

Are Hemorrhoids Associated with False-Positive Fecal Immunochemical Test Results?

Kim

Park

et al. 2017

Yonsei Med J

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PurposeFalse-positive (FP) results of fecal immunochemical tests (FITs) conducted in colorectal cancer (CRC) screening could lead to performing unnecessary colonoscopies. Hemorrhoids are a possible cause of FP FIT results; however, studies on this topic are extremely rare. We investigated whether hemorrhoids are associated with FP FIT results.Materials and MethodsA retrospective study was conducted at a university hospital in Korea from June 2013 to May 2015. Of the 34547 individuals who underwent FITs, 3946 aged ≥50 years who underwent colonoscopies were analyzed. Logistic regression analysis was performed to determine factors associated with FP FIT results.ResultsAmong 3946 participants, 704 (17.8%) showed positive FIT results and 1303 (33.0%) had hemorrhoids. Of the 704 participants with positive FIT results, 165 had advanced colorectal neoplasia (ACRN) and 539 had no ACRN (FP results). Of the 1303 participants with hemorrhoids, 291 showed FP results, of whom 81 showed FP results because of hemorrhoids only. Participants with hemorrhoids had a higher rate of FP results than those without hemorrhoids (291/1176, 24.7% vs. 248/2361, 10.5%; p<0.001). Additionally, the participants with hemorrhoids as the only abnormality had a higher rate of FP results than those experiencing no such abnormalities (81/531, 15.3% vs. 38/1173, 3.2%; p<0.001). In multivariate analysis, the presence of hemorrhoids was identified as an independent predictor of FP results (adjusted odds ratio, 2.76; 95% confidence interval, 2.24–3.40; p<0.001).ConclusionHemorrhoids are significantly associated with FP FIT results. Their presence seemed to be a non-negligible contributor of FP results in FIT-based CRC screening programs.

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“…[9][10][11][12][13][14][15][16][17][18] Moreover, most of these studies were conducted with guaiac-based FOBT. 9,10,12,[15][16][17][18] Levi et al investigated the effect of aspirin, non-steroidal antiinflammatory drugs and anticoagulants on the performance of iFOBT, but that study was not carried out in a screening setting. 14 Hence, as to iFOBT, there are still few data on the effect of antithrombotic drugs.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, if antithrombotic drugs do not affect the diagnostic performance of iFOBT, it is desirable that they should be continued. Concerning this issue, there are scant and controversial data . Moreover, most of these studies were conducted with guaiac‐based FOBT .…”

Section: Introductionmentioning

confidence: 99%

Antithrombotic drug does not affect the positive predictive value of an immunochemical fecal occult blood test

Tsuji

Gunji

Sato

et al. 2013

Digestive Endoscopy

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Background and Aim Antithrombotic drugs may affect the diagnostic performance of immunochemical fecal occult blood test (iFOBT) for colorectal cancer (CRC) screening. The aim of the present study was to assess the effect of antithrombotic drugs on the diagnostic performance of iFOBT. Methods We analyzed 1016 patients who underwent colonoscopy for positive iFOBT. Patients were classified as follows: patients who had advanced neoplasms detected and those who did not; patients who had cancers detected and those who did not; patients who had any neoplasms detected and those who did not. We compared the following factors between two paired groups: sex, age, endoscopists' experience, and antithrombotic drug usage. Results A total of 139 patients were taking antithrombotic drugs (13.7%). Advanced neoplasms, cancers, and any neoplasms were detected in 196 (19.3%), 59 (5.8%), and 490 (48.2%)patients, respectively. There were no higher detection rates in the antithrombotic drug (–) group than in the (+) group (advanced neoplasms: 19.3% vs 19.4%, P = 1.000; cancers: 5.8% vs 5.8%, P = 1.000; any neoplasms: 48.4% vs 47.5%, P = 0.856). Multivariate logistic regression analysis revealed that none of aspirin, warfarin, or other antithrombotic drugs was a significant factor for advanced neoplasms (95% CI 0.350–1.216, P = 0.179; 95% CI 0.421–1.899, P = 0.772; 95% CI 0.323–1.810, P = 0.764, respectively). As to cancers and any neoplasms, no antithrombotic drug also proved to be a significant factor. Conclusion The present study demonstrated that the positive predictive value of iFOBT was not affected by ongoing antithrombotic therapy.

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Aspirin Users Attending for NHS Bowel Cancer Screening Have Less Colorectal Neoplasia: Chemoprevention or False-Positive Faecal Occult Blood Testing?

Cited by 15 publications

References 14 publications

Comparison of screen-detected and interval colorectal cancers in the Bowel Cancer Screening Programme

Comparison of screen-detected and interval colorectal cancers in the Bowel Cancer Screening Programme

Are Hemorrhoids Associated with False-Positive Fecal Immunochemical Test Results?

Antithrombotic drug does not affect the positive predictive value of an immunochemical fecal occult blood test

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