Detection of cancers and advanced adenomas in asymptomatic participants in colorectal cancer screening: a cross-sectional study

Abstract

ObjectivesTo assess detection rates for colorectal cancer (CRC) and advanced adenomas in asymptomatic CRC screening participants and bowel symptoms in association with CRC and advanced adenoma.DesignCross-sectional study.SettingTwo screening centres.Participants42 554 men and women, aged 50–74 years, participating in a randomised CRC screening trial. 36 059 participants underwent a sigmoidoscopy (and follow-up colonoscopy if positive sigmoidoscopy) and 6495 underwent a colonoscopy after a positive faecal immunochemical test (FIT).Primary and secondary outcome measuresProportion of asymptomatic participants diagnosed with CRC or advanced adenomas. Prevalence of bowel symptoms (rectal bleeding, change in bowel habits, diarrhoea, constipation, bloating, alternating bowel habits, general symptoms, other bowel symptoms) recorded by the endoscopist and their association with CRC and advanced adenomas.ResultsAmong sigmoidoscopy participants, 7336 (20.3%) reported at least one symptom. 120 (60%) out of 200 individuals with screen-detected CRC and 1301 (76.5%) out of 1700 with advanced adenoma were asymptomatic. Rectal bleeding was associated with detection of CRC and advanced adenoma (OR 4.3, 95% CI 3.1 to 6.1 and 1.8, 95% CI 1.5 to 2.1, respectively), while change in bowel habits only with CRC detection (OR 3.8, 95% CI 2.4 to 6.1). Among the FIT positives, 2173 (33.5%) reported at least one symptom. Out of 299 individuals with screen-detected CRC and 1639 with advanced adenoma, 167 (55.9%) and 1 175 (71.7%) were asymptomatic, respectively. Detection of CRC was associated with rectal bleeding (OR 1.8, 95% CI 1.4 to 2.3), change in bowel habits (OR 2.2, 95% CI 1.4 to 3.5) and abdominal pain (OR 1.8, 95% CI 1.2 to 2.7).ConclusionsSome bowel symptoms increased the likelihood of being diagnosed with CRC or advanced adenoma. However, the majority of individuals with these findings were asymptomatic. Asymptomatic individuals should be encouraged to participate in CRC screening.Trial registration numberClinicaltrials.gov Identifier: NCT01538550.

A GNAS Gene Mutation’s Independent Expression in the Growth of Colorectal Cancer: A Systematic Review and Meta-Analysis

“…It is well known that the incidence of genomic and epigenetic alterations leading to tumourigenesis is dynamic [ 59 , 60 ]. In the present study, the majority of the selected patients were adults, with the majority of them being over 50 years old, suggesting that GNAS gene mutation dominates in the adult population.…”

A Systematic Review and Meta-analysis on the Occurrence of Biomarker Mutation in Colorectal Cancer among the Asian Population

“…The dynamic of gene expression patterns on gender and age was investigated by some studies as a possible risk for developing CRC [ 120 , 121 ]. In this study, the age of the participants was also taken into consideration, the bulk of the recruited participants were adults, with most of them being over 50 years old, implying that KRAS gene mutation predominates in adult CRC.…”

NF-κB Activator 1 downregulation in macrophages activates STAT3 to promote adenoma-adenocarcinoma transition and immunosuppression in colorectal cancer

“…2 Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China. 3 • fast, convenient online submission…”

“…A total of 60–90% of sporadic CRC arise via the classical adenoma-carcinoma pathway [ 2 ]. Advanced adenomas are the most frequent premalignant precursor lesions of sporadic CRC [ 3 , 4 ]. The transition from tubular adenoma to adenocarcinoma occurs over a period of more than 10 to 15 years [ 5 ].…”