Iron‐deficiency anaemia and delay in the diagnosis of colorectal cancer

Acher, Peter; Al-Mishlab, Talib; Rahman, Mahbubur; Bates, Tom

doi:10.1046/j.1463-1318.2003.00415.x

Cited by 39 publications

(39 citation statements)

References 9 publications

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“…This result is partially consistent with the literature (3,12) and has been observed in a significant manner in patients with a history of proctorrhagia and/or loss of more than 10% of body weight, and in cases with low HB, HT, MCV and serum iron. This finding confirms the frequent association of a history of chronic colorectal bleeding, low ferritin levels and microcytic and iron deficiency anemia (12,26,28,29). In particular, over a quarter (28.5%) of our patients with right colon cancer had low ferritin values compared to patients with left colon (8.8%) or rectal (12.8%) cancers.…”

Section: Discussionsupporting

confidence: 87%

“…Over 40% of our patients had a hemoglobin level lower than the normal laboratory range (9.5% of patients had a HB value ≤10 g/dL), showing a rather high incidence of mild anemia in colorectal cancer patients, but only 32.5% of these patients had low serum ferritin values. Anemia at the time of diagnosis of colorectal cancer is reported in about 25-45% of cases, depending on the HB value selected as the criterion for anemia (28,29). This anemia has been associated with iron deficiency (12,28,29) but low-grade anemia may also be related to impaired iron utilization (2,4,12,15).…”

Section: Discussionmentioning

confidence: 99%

“…Anemia at the time of diagnosis of colorectal cancer is reported in about 25-45% of cases, depending on the HB value selected as the criterion for anemia (28,29). This anemia has been associated with iron deficiency (12,28,29) but low-grade anemia may also be related to impaired iron utilization (2,4,12,15). A significant relationship between HB values of less than 10 g/dL and the age of patients and the size and site of tumors in colorectal cancer has been reported in a multivariate analysis (29).…”

Section: Discussionmentioning

confidence: 99%

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Serum Ferritin in Colorectal Cancer Patients and its Prognostic Evaluation

Lorenzi

Vernillo

2006

Int J Biol Markers

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The aim of this study was to investigate the relationship between preoperative serum ferritin levels, clinicopathological parameters and survival analysis of patients with colorectal cancer. Ninety-four patients (57 males) with a mean age of 65 years (39-87 years) underwent 63 curative and 31 palliative operations. Follow-up was at least 5 years. Patients were categorized with normal (30-215 ng/mL in men and 11-148 ng/mL in women), low, or high serum ferritin levels. Prognostic evaluation was undertaken with stratified survival analysis and Cox's regression model. Twenty-nine of the patients (30.9%) had raised ferritin levels and 14 (14.9%) had low values. Comparisons of the survival curves showed significant differences in stage C disease; specifically, patients with either low or high ferritin levels had a shorter survival than patients with normal levels. Patients who underwent palliative surgery and had high ferritin serum values also had a shorter survival. In multivariate analysis, the variables with a negative effect on survival were stage, serum ferritin levels and age. Our data suggest that patients with advanced colorectal cancer having normal preoperative serum ferritin levels may have a better prognosis, although the prognostic value related to this association requires further investigation.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Serum Ferritin in Colorectal Cancer Patients and its Prognostic Evaluation

Lorenzi

Vernillo

2006

Int J Biol Markers

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“…A random sample of 900 KPNW adults with CRC (and having at least one prior CBC) who were at least 40 years of age at the time of disease onset, and a random sample of 16,195 healthy KPNW controls were created.…”

Section: Study Population Selection and Matchingmentioning

confidence: 99%

“…Blood loss is present in 60% of CRC cases, and a daily loss of as little as 3 mL in the stool can cause iron deficiency anemia [15]. However, as only 18% of CRC cases had anemia more than a year before diagnosis [16], a significant proportion of the population is not anemic [17]. The fecal occult blood test detects only current bleeding, while in CRC, blood loss is commonly intermittent [10].…”

mentioning

confidence: 99%

Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data

Hornbrook

Goshen²,

Choman³

et al. 2017

Dig Dis Sci

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Background Machine learning tools identify patients with blood counts indicating greater likelihood of colorectal cancer and warranting colonoscopy referral. Aims To validate a machine learning colorectal cancer detection model on a US community-based insured adult population. Methods Eligible colorectal cancer cases (439 females, 461 males) with complete blood counts before diagnosis were identified from Kaiser Permanente Northwest Region's Tumor Registry. Control patients (n = 9108) were randomly selected from KPNW's population who had no cancers, received at C1 blood count, had continuous enrollment from 180 days prior to the blood count through 24 months after the count, and were aged 40-89. For each control, one blood count was randomly selected as the pseudo-colorectal cancer diagnosis date for matching to cases, and assigned a ''calendar year'' based on the count date. For each calendar year, 18 controls were randomly selected to match the general enrollment's 10-year age groups and lengths of continuous enrollment. Prediction performance was evaluated by area under the curve, specificity, and odds ratios. Results Area under the receiver operating characteristics curve for detecting colorectal cancer was 0.80 ± 0.01. At 99% specificity, the odds ratio for association of a high-risk detection score with colorectal cancer was 34.7 (95% CI 28.9-40.4). The detection model had the highest accuracy in identifying right-sided colorectal cancers. Conclusions ColonFlag Ò identifies individuals with tenfold higher risk of undiagnosed colorectal cancer at curable stages (0/I/II), flags colorectal tumors 180-360 days prior to usual clinical diagnosis, and is more accurate at identifying right-sided (compared to left-sided) colorectal cancers.

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Increased diagnostic activity in general practice during the year preceding colorectal cancer diagnosis

2015

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Accurate diagnostic activity in general practice before colorectal cancer (CRC) diagnosis is crucial for an early detection of CRC. This study aimed to investigate the rates of daytime consultations, hemoglobin (Hb) measurements and medicine prescriptions for hemorrhoids in general practice in the year preceding CRC diagnosis. Using Danish registries, we conducted a population-based matched cohort study including CRC patients aged 40-80 years (n 5 19,209) and matched references (n 5 192,090). We calculated odds ratios (ORs) using a conditional logistical regression model and incidence rate ratios (IRRs) using a negative binomial regression model. The CRC patients had significantly more consultations from 9 months before diagnosis and significantly increased rates of Hb measurements from up to 17 months before diagnosis compared with references. Furthermore, up to 18 months before diagnosis, CRC patients had significantly higher rates of prescriptions for hemorrhoids; and 2 months before diagnosis, the IRR was 12.24 (95% confidence interval (CI): 10.29-14.55) for men. The positive predictive value (PPV) of CRC for having a first-time prescription for hemorrhoids was highest among men aged 70-80 years [PPV 5 3.2% (95% CI: 2.8-3.7)]. High prescription rates were predominantly seen among rectal cancer patients, whereas colon cancer patients had higher rates of consultations and Hb measurements. This study revealed a significant increase in healthcare seeking and diagnostic activity in general practice in the year prior to CRC diagnosis, which indicates the presence of a "diagnostic time window" and a potential for earlier diagnosis of CRC based on clinical signs and symptoms.

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Iron‐deficiency anaemia and delay in the diagnosis of colorectal cancer

Abstract: The investigation of iron-deficiency anaemia in older patients is important but in order to detect 26 patients with colorectal cancer a year earlier, the investigation of approximately 5000 patients would be required--a detection rate of less than 1%.

Cited by 39 publications

References 9 publications

Serum Ferritin in Colorectal Cancer Patients and its Prognostic Evaluation

Serum Ferritin in Colorectal Cancer Patients and its Prognostic Evaluation

Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data

Increased diagnostic activity in general practice during the year preceding colorectal cancer diagnosis

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