Yonsei Med J.  2017 Sep;58(5):910-917. 10.3349/ymj.2017.58.5.910.

A Combination of Fecal Immunochemical Test Results and Iron Deficiency Anemia for Detection of Advanced Colorectal Neoplasia in Asymptomatic Men

Affiliations
  • 1Preventive Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Seoul, Korea.
  • 3Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. ys810.jung@samsung.com

Abstract

PURPOSE
A substantial proportion of patients with colorectal cancer (CRC) present with iron deficiency anemia (IDA), and fecal immunochemical test (FIT) has proven to be an effective method for detecting the majority of CRC cases. A combination strategy of FIT results and IDA may be useful for risk stratification for detecting advanced colorectal neoplasia (ACRN). We compared the prevalence of ACRN among four groups stratified by FIT results and the presence of IDA.
MATERIALS AND METHODS
A cross-sectional study was performed on asymptomatic male participants who underwent both FIT and colonoscopy between 2010 and 2014 as part of a comprehensive health screening program in Korea.
RESULTS
Of 17236 participants, 522 (3.0%) showed positive FIT results and 26 (0.2%) had IDA. The mean age of the study participants was 40.8 years. The participants were classified into four groups: positive FIT result/IDA (G1, n=7), positive FIT result/no IDA (G2, n=515), negative FIT result/IDA (G3, n=19), and negative FIT result/no IDA (G4, n=16695). The prevalences of ACRN in G1, G2, G3, and G4 were 28.6, 13.4, 5.3, and 1.5%, respectively (p<0.001) and those of CRC were 28.6, 1.6, 0.0, and 0.01%, respectively (p<0.001). Subjects with positive FIT results and IDA had an increased risk of ACRN and CRC in both group aged <50 and ≥50 years.
CONCLUSION
Subjects with positive FIT results and IDA had an increased risk of ACRN. Our results suggest that a combination strategy of FIT and IDA may be helpful in selecting and prioritizing asymptomatic men for colonoscopy.

Keyword

Fecal immunochemical test; iron deficiency anemia; advanced colorectal neoplasia

MeSH Terms

Adult
Anemia, Iron-Deficiency/*diagnosis
Colorectal Neoplasms/*diagnosis/epidemiology
Cross-Sectional Studies
Early Detection of Cancer
Feces/*chemistry
Humans
Immunohistochemistry
Male
Middle Aged
Neoplasm Staging
Prevalence

Figure

  • Fig. 1 Flow diagram illustrating the selection of study subjects. FIT, fecal immunochemical test; IDA, iron deficiency anemia.

  • Fig. 2 Prevalence of ACRN according to FIT results and presence of IDA. *p<0.001. ACRN, advanced colorectal neoplasia; FIT, fecal immunochemical test; IDA, iron deficiency anemia.


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