Biology and clinical implications of fecal occult blood test screen-detected colorectal cancer

Mendis, S; Hong, W; Ananda, S; Faragher, I; Jones, I; Croxford, M; Steel, M; Jalali, A; Gard, G; To, YH; Lee, M; Kosmider, S; Wong, R; Tie, J; Gibbs, P

Author(s): Mendis, S; Hong, W; Ananda, S; Faragher, I; Jones, I; Croxford, M; Steel, M; Jalali, A; Gard, G; To, YH; Lee, M; Kosmider, S; Wong, R; Tie, J; Gibbs, P;
Details: Publication Year 2022-01-05,Volume 6,Issue #1,Page pkab100
Journal Title: JNCI Cancer Spectrum
Abstract: BACKGROUND: Fecal occult blood test (FOBT)-based screening for colorectal cancer (CRC) reduces mortality, with earlier stage at diagnosis a prominent feature. Other characteristics of FOBT screen-detected cancers and any implications for clinical management have not been well explored. METHODS: We examined a multisite clinical registry to compare the characteristics and outcomes of FOBT screen-detected CRC via the Australian National Bowel Cancer Screening Program (NBCSP), which is offered biennially to individuals aged 50-74 years, and age-matched non-screen-detected CRC in the same registry. All statistical tests were 2-sided. Odds ratios (ORs) were calculated using the Baptista-Pike method, and hazard ratios via the log-rank method. RESULTS: Of 7153 registry patients diagnosed June 1, 2006, to June 30, 2020, 4142 (57.9%) were aged between 50 and 74 years. Excluding 406 patients with non-NBCSP screen-detected cancers and 35 patients with unknown method of detection, 473 (12.8%) were screen detected via the NBCSP, and 3228 (87.2%) were non-screen detected. Screen-detected patients were younger (mean age = 62.4 vs 64.2 years; P < .001) and more medically fit (OR for ASA score 1-2 = 1.91, 95% confidence interval [CI] = 1.51 to 2.41; P < .001). Pathologic characteristics within each stage favored the screen-detected patients. Stage III screen-detected colon cancers were more likely to receive adjuvant therapy (OR = 3.58, 95% CI = 1.52 to 8.36; P = .002). Screen-detected patients had superior relapse-free (hazard ratio = 0.41, 95% CI = 0.29 to 0.60; P < .001) and overall survival (hazard ratio = 0.22, 95% CI = 0.15 to 0.35; P < .001), which was maintained in matched stage comparisons and multivariable analysis. CONCLUSIONS: Beyond stage at diagnosis, multiple other factors associated with a favorable outcome are observed in FOBT screen-detected CRC. Given the substantial stage-by-stage differences in survival outcomes, if independently confirmed, individualized adjuvant therapy and surveillance strategies could be warranted for FOBT screen-detected cancers.
Publisher: Oxford Academic
Research Division(s): Personalised Oncology
PubMed ID: 35699496
Publisher's Version: https://doi.org/10.1093/jncics/pkab100
Open Access at Publisher's Site: https://doi.org/10.1093/jncics/pkab100
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2022-06-17 10:01:22

Last Modified: 2022-06-21 10:39:15