Background

In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60–69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding.

Methods

By electronically linking BCSP and Million Women Study records, we identified 604 495 women without previous colorectal cancer who participated in their first routine FOBt screening between 2006 and 2012. Regression models, using linked national hospital admission records, yielded adjusted relative risks (RRs) in FOBt-positive versus FOBt-negative women for colorectal cancer, adenoma, diverticular disease, inflammatory bowel disease, haemorrhoids, upper gastrointestinal cancer, oesophagitis, peptic ulcer, anaemia and other haematological disorders.

Findings

RRs in FOBt-positive versus FOBt-negative women were 201.3 (95% CI 173.8–233.2) for colorectal cancer and 197.9 (95% CI 180.6–216.8) for adenoma within 12 months after screening and 3.49 (95% CI 2.31–5.26) and 4.88 (95% CI 3.80–6.26), respectively, 12–24 months after screening; P < 0.001 for all RRs. In the 12 months after screening, the RR for inflammatory bowel disease was 26.3 (95% CI 19.9–34.7), and ranged between 2 and 5 for the upper gastrointestinal or haematological disorders. The RRs of being diagnosed with any of the eight conditions other than colorectal neoplasms before screening, and in the 12–24 months after screening, were 1.81 (95% CI 1.81–2.01) and 1.92 (95% CI 1.66–2.13), respectively.

Conclusions

Whereas FOBt positivity is associated with a substantially increased risk of colorectal neoplasms after screening, eight other gastrointestinal and haematological conditions are also associated with FOBt positivity, both before and after screening.

中文翻译：

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常规筛查中十种胃肠道和其他医疗状况与粪便潜血检测呈阳性的关联：一项针对英格兰女性的大型前瞻性研究

 背景

2006 年，英国肠癌筛查计划 (BCSP) 开始在 60-69 岁人群中每两年进行一次粪便潜血检测 (FOBt)。尽管 FOBt 旨在检测结直肠肿瘤，但其他条件也会影响结果。在英国的一项大型前瞻性研究中，我们检查了筛查前后 FOBt 阳性与 10 种通常与胃肠道出血相关的疾病之间的关联。

 方法

通过电子链接 BCSP 和百万女性研究记录，我们确定了 604 495 名既往没有结直肠癌的女性，她们在 2006 年至 2012 年间参加了第一次常规 FOBt 筛查。回归模型使用链接的国家医院入院记录，得出了调整后的相对风险 (RR)： FOBt 阳性与 FOBt 阴性女性结直肠癌、腺瘤、憩室病、炎症性肠病、痔疮、上消化道癌、食管炎、消化性溃疡、贫血和其他血液疾病的比较。

 发现

筛查后 12 个月内，FOBt 阳性与 FOBt 阴性女性中，结直肠癌的 RR 分别为 201.3 (95% CI 173.8–233.2)，腺瘤的 RR 为 197.9 (95% CI 180.6–216.8)，腺瘤的 RR 为 3.49 (95% CI 2.31–5.26)筛选后 12-24 个月，分别为 4.88 (95% CI 3.80-6.26)；所有 RR 的 P < 0.001。筛查后 12 个月内，炎症性肠病的 RR 为 26.3（95% CI 19.9-34.7），上消化道或血液疾病的 RR 范围为 2 至 5。在筛查前和筛查后 12-24 个月内被诊断患有结直肠肿瘤以外的八种疾病中的任何一种的 RR 分别为 1.81 (95% CI 1.81-2.01) 和 1.92 (95% CI 1.66-2.13) 。

 结论

虽然 FOBt 阳性与筛查后结直肠肿瘤风险显着增加相关，但其他八种胃肠道和血液学疾病也与筛查前后的 FOBt 阳性相关。