Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
BMJ Open. 2021 Jul 1;11(7):e048183. doi: 10.1136/bmjopen-2020-048183.
To assess detection rates for colorectal cancer (CRC) and advanced adenomas in asymptomatic CRC screening participants and bowel symptoms in association with CRC and advanced adenoma.
Cross-sectional study.
Two screening centres.
42 554 men and women, aged 50-74 years, participating in a randomised CRC screening trial. 36 059 participants underwent a sigmoidoscopy (and follow-up colonoscopy if positive sigmoidoscopy) and 6495 underwent a colonoscopy after a positive faecal immunochemical test (FIT).
Proportion of asymptomatic participants diagnosed with CRC or advanced adenomas. Prevalence of bowel symptoms (rectal bleeding, change in bowel habits, diarrhoea, constipation, bloating, alternating bowel habits, general symptoms, other bowel symptoms) recorded by the endoscopist and their association with CRC and advanced adenomas.
Among sigmoidoscopy participants, 7336 (20.3%) reported at least one symptom. 120 (60%) out of 200 individuals with screen-detected CRC and 1301 (76.5%) out of 1700 with advanced adenoma were asymptomatic. Rectal bleeding was associated with detection of CRC and advanced adenoma (OR 4.3, 95% CI 3.1 to 6.1 and 1.8, 95% CI 1.5 to 2.1, respectively), while change in bowel habits only with CRC detection (OR 3.8, 95% CI 2.4 to 6.1). Among the FIT positives, 2173 (33.5%) reported at least one symptom. Out of 299 individuals with screen-detected CRC and 1639 with advanced adenoma, 167 (55.9%) and 1 175 (71.7%) were asymptomatic, respectively. Detection of CRC was associated with rectal bleeding (OR 1.8, 95% CI 1.4 to 2.3), change in bowel habits (OR 2.2, 95% CI 1.4 to 3.5) and abdominal pain (OR 1.8, 95% CI 1.2 to 2.7).
Some bowel symptoms increased the likelihood of being diagnosed with CRC or advanced adenoma. However, the majority of individuals with these findings were asymptomatic. Asymptomatic individuals should be encouraged to participate in CRC screening.
Clinicaltrials.gov Identifier: NCT01538550.
评估无症状结直肠癌（CRC）筛查参与者中 CRC 和高级腺瘤的检出率，以及与 CRC 和高级腺瘤相关的结直肠症状。
横断面研究。
两个筛查中心。
42554 名年龄在 50-74 岁的男性和女性，参加了一项随机 CRC 筛查试验。36059 名参与者接受了乙状结肠镜检查（如果乙状结肠镜检查阳性则进行后续结肠镜检查），6495 名参与者接受了粪便免疫化学试验（FIT）阳性后的结肠镜检查。
无症状参与者中诊断为 CRC 或高级腺瘤的比例。记录内镜医生记录的结直肠症状（直肠出血、排便习惯改变、腹泻、便秘、腹胀、交替排便习惯、全身症状、其他结直肠症状）及其与 CRC 和高级腺瘤的关系。
在乙状结肠镜检查参与者中，7336 名（20.3%）报告了至少一种症状。200 名筛查发现的 CRC 患者中有 120 名（60%）和 1700 名高级腺瘤患者中有 1301 名（76.5%）无症状。直肠出血与 CRC 和高级腺瘤的检出相关（OR 4.3，95%CI 3.1-6.1 和 1.8，95%CI 1.5-2.1），而排便习惯改变仅与 CRC 检出相关（OR 3.8，95%CI 2.4-6.1）。在 FIT 阳性者中，2173 名（33.5%）报告了至少一种症状。在 299 名筛查发现的 CRC 患者和 1639 名高级腺瘤患者中，分别有 167 名（55.9%）和 1175 名（71.7%）无症状。CRC 的检出与直肠出血（OR 1.8，95%CI 1.4-2.3）、排便习惯改变（OR 2.2，95%CI 1.4-3.5）和腹痛（OR 1.8，95%CI 1.2-2.7）相关。
一些结直肠症状增加了诊断为 CRC 或高级腺瘤的可能性。然而，大多数有这些发现的人是无症状的。应鼓励无症状个体参加 CRC 筛查。
Clinicaltrials.gov 标识符：NCT01538550。
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