The yield of colorectal cancer among fast track patients with normocytic and microcytic anaemia

Panagiotopoulou, IG; Fitzrol, Diana Noma; Parker, R.; Kuzhively, Julie; Luscombe, N; Wells, A D; Menon, Madhav C.; Bajwa, FM; Watson, MA

doi:10.1308/003588414x13814021680076

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…Panagiotopoulou et al have done a similar study have found in their study that microcytosis has a greater predictive value in diagnosing CRC when compare to anaemia or ferritin levels. They also observed that levels of haemoglobin were not statistically significantly linked to CRC (10). Their study attest to our findings to some extent as far as sensitivity of microcytosis for CRC is concerned.…”

Section: Comparison With Existing Literaturesupporting

confidence: 85%

Non-anaemic iron deficiency should be investigated with the same priority as iron deficiency anaemia in fast track colorectal clinics—retrospective cohort study

Majeed¹,

Solomon²,

Ali³

et al. 2020

J Gastrointest Oncol

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Background: Since year 2000 the diagnostic criterion for fast track (FT) referrals for patients with suspected colorectal cancer (CRC) is used in the UK. Iron deficiency anaemia (IDA) is one of the diagnostic criteria. There is a strong evidence in the literature which suggests that Iron deficiency (ID) alone has a strong relationship with CRC. Non-anaemic Iron deficiency (NAID) and all other types of anaemia are investigated outside the scope of FT clinics. We postulated that patients with ID regardless of degree of anaemia have an increased risk of CRC. By confirming this hypothesis, we can broaden the scope of the diagnostic criterion for referral that can help to increase diagnostic yield of FT CRC services.Methods: A retrospective observational cohort study was conducted from a dedicated data for FT clinics from 2016-2018. Association between CRC and different forms of anaemia, Iron deficiency alone and bowel symptoms was determined.Results: Patients with iron deficiency (low MCV, MCH and ferritin) regardless of degree of anaemia were found more likely to have CRC. Factors like age, gender, family history and bowel symptoms (except abdominal mass) showed a very weak association with CRC in patients with ID.Conclusions: ID without anaemia has a strong relationship with CRC and should be investigated with the same priority as IDA is investigated.

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Section: Comparison With Existing Literaturesupporting

confidence: 85%

Non-anaemic iron deficiency should be investigated with the same priority as iron deficiency anaemia in fast track colorectal clinics—retrospective cohort study

Majeed¹,

Solomon²,

Ali³

et al. 2020

J Gastrointest Oncol

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“…Of these, 1655 were excluded because they were not conducted in the UK or were not in accordance with NICE guidance. The full texts of the remaining 95 records were reviewed, of which 49 were included in the review . Of the 49 included publications, one reported two datasets from different centres .…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

Mozdiak

Ghebremichael‐Weldeselassie

McFarlane

et al. 2019

Aliment Pharmacol Ther

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Summary Background National UK data on colorectal cancer (CRC) stage at diagnosis is incomplete. Site‐specific fast‐track (2‐week wait) cancer data are not collected directly by NHS England. Policy making based on these data alone can lead to inaccuracy. Aims To review available data on key outcomes (cancer conversion rate and stage at diagnosis) for the UK's lower gastrointestinal 2‐week wait pathway. Methods A comprehensive literature search was conducted between 2000 and 2017. Primary outcomes were cancer conversion rate and cancer stage at diagnosis. Results were expressed as proportions with 95% CIs. A random effects model was used for meta‐analysis; heterogeneity was assessed by I2. Results Of 95 papers reviewed, 49 were included in analysis with a total study population of 93,655. Cancer conversion rate was 7.7% (95% CI: 6.9‐8.5). The proportion presenting at Dukes A = 11.2% (95% CI 7.4‐15.6), B = 36.7% (95% CI 30.8‐42.8), C = 35.7% (95% CI: 30.8‐40.8) and D = 11.1% (95% CI 7.3‐15.5). No colonic pathology was diagnosed in 54.6% (95% CI: 46.2‐62.8). Conclusions Only 7.7% of patients referred by the 2‐week wait pathway were found to have CRC. No beneficial effect on stage at diagnosis was found compared to non‐2‐week wait referral pathways. Over half of patients had no colonic pathology and detection of adenomas was very low. These results should prompt a reconsideration of the benefits of the 2‐week wait pathway in CRC diagnosis and outcomes, with more focus on strategies to improve patient selection.

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“…At zero to six months before diagnosis, all studies reported an association between mean corpuscular volume and colorectal cancer diagnosis. Panagiotopoulou 2014 [49] suggest that the odds of diagnosis in three months do not differ between those with mean corpuscular volume < 80 fL and ≥ 80 fL when unadjusted (OR = 1.73, 95% CI = 0.96-3.1), but do when adjusted for other factors (OR = 2.2, 95% CI = 1.2-4.1). Goshen 2017 [28] reported a statistically significant difference in mean corpuscular volume between those with and without a future diagnosis (t-tests p < 0.0001), with cases having 3.67 fL lower on average.…”

Section: Mean Corpuscular Volumementioning

confidence: 99%

“…Panagiotopoulou 2014 [49] compared the yield of 3-month colorectal cancer between patients with microcytic (mean corpuscular volume < 80 fL) anaemia (haemoglobin below lower limit of normal for each centre) with the rest of the patients in their study. Those with microcytic anaemia had a statistically significantly different yield of colorectal cancer in one (p = 0.019) of the two recruiting centres but not the other (p = 0.285).…”

Section: Combined Componentsmentioning

confidence: 99%

The Full Blood Count Blood Test for Colorectal Cancer Detection: A Systematic Review, Meta-Analysis, and Critical Appraisal

Virdee

Marian

Mansouri

et al. 2020

Cancers

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Introduction: A full blood count (FBC) blood test includes 20 components. We systematically reviewed studies that assessed the association of the FBC and diagnosis of colorectal cancer to identify components as risk factors. We reviewed FBC-based prediction models for colorectal cancer risk. Methods: MEDLINE, EMBASE, CINAHL, and Web of Science were searched until 3 September 2019. We meta-analysed the mean difference in FBC components between those with and without a diagnosis and critically appraised the development and validation of FBC-based prediction models. Results: We included 53 eligible articles. Three of four meta-analysed components showed an association with diagnosis. In the remaining 16 with insufficient data for meta-analysis, three were associated with colorectal cancer. Thirteen FBC-based models were developed. Model performance was commonly assessed using the c-statistic (range 0.72–0.91) and calibration plots. Some models appeared to work well for early detection but good performance may be driven by early events. Conclusion: Red blood cells, haemoglobin, mean corpuscular volume, red blood cell distribution width, white blood cell count, and platelets are associated with diagnosis and could be used for referral. Existing FBC-based prediction models might not perform as well as expected and need further critical testing.

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The yield of colorectal cancer among fast track patients with normocytic and microcytic anaemia

Cited by 7 publications

References 13 publications

Non-anaemic iron deficiency should be investigated with the same priority as iron deficiency anaemia in fast track colorectal clinics—retrospective cohort study

Non-anaemic iron deficiency should be investigated with the same priority as iron deficiency anaemia in fast track colorectal clinics—retrospective cohort study

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

The Full Blood Count Blood Test for Colorectal Cancer Detection: A Systematic Review, Meta-Analysis, and Critical Appraisal

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