Publications by authors named "Judith Strachan"
Article Synopsis
- Lynch syndrome (LS) patients have a high risk of colorectal cancer, currently monitored through biennial colonoscopy, which can be burdensome and invasive.
- This study assessed whether faecal immunochemical testing (FIT) for faecal haemoglobin could effectively replace the need for routine colonoscopy in LS surveillance.
- Results showed FIT has low sensitivity for detecting adenomas, with no improvement when a second test was added, suggesting it may not be a viable alternative to colonoscopy.
Aim: Since December 2015, a faecal immunochemical test (FIT) has been provided to primary care in NHS Tayside as an adjunct to clinical acumen in the assessment of new-onset bowel symptoms. The aim of this work was to assess the impact of this approach on time to diagnosis of colorectal cancer (CRC).
Method: NHS Tayside Cancer audit data from January 2013 to December 2019 were reviewed to identify all CRC patients diagnosed via the primary-care referral pathway for a period before and after the introduction of FIT.
Article Synopsis
- The study aimed to improve colorectal cancer (CRC) detection by using risk scoring models (RSMs) alongside faecal immunochemical testing (FIT) in symptomatic patients, potentially reducing the need for endoscopies.
- By analyzing data from nearly 19,000 patients, key factors such as faecal haemoglobin levels, age, sex, and iron deficiency were identified to create a risk score that improved sensitivity for detecting CRC compared to standard f-Hb thresholds.
- The findings suggest that while RSMs may enhance detection in some cases, they did not significantly help patients with very low f-Hb levels, indicating a need for alternative strategies that incorporate additional risk factors beyond just FIT.
Objective: To compare interval cancer proportions (ICP) in the faecal immunochemical test (FIT)-based Scottish Bowel Screening Programme (SBoSP) with the former guaiac faecal occult blood test (gFOBT)-based SBoSP and investigate associations between interval cancer (IC) and faecal haemoglobin concentration (f-Hb) threshold, sex, age, deprivation, site, and stage.
Methods: The ICP data from first year of the FIT-based SBoSP and the penultimate year of the gFOBT-based SBoSP were compared in a prospective cohort design.
Results: With FIT, 801 colorectal cancers (CRCs) were screen detected (SDC), 802 were in non-participants, 548 were ICs, 39 were colonoscopy missed and 72 were diagnosed after incomplete screening; with gFOBT: 540, 904, 556, 45, and 13, respectively.
Article Synopsis
- A study aimed to create a risk-scoring model for colorectal cancer by analyzing faecal haemoglobin levels and other factors in participants of the Scottish Bowel Screening Programme.
- Data from over 232,000 participants revealed that only faecal haemoglobin concentration and age were significantly linked to colorectal cancer, with a notable interval cancer rate, particularly higher in women (38.1%) than men (27.5%).
- The findings suggest that developing a risk scoring model was not achievable, but adjusting faecal haemoglobin thresholds by age may help address the gender disparity in cancer detection rates.
Article Synopsis
- Colorectal cancer (CRC) screening through faecal tests has reduced mortality rates, prompting a study to examine sex and age-related differences in mortality trends in Scotland from 1990 to 2020.
- The analysis showed that while CRC mortality generally declined over this period, the rate of decline varied significantly between men and women, with men experiencing a more substantial decrease following the start of screening.
- The findings suggest that screening programs had a more pronounced beneficial impact on men's CRC mortality and indicate the need for sex-specific thresholds in screening to promote equality in health outcomes.
Article Synopsis
- The study assessed the impact of faecal immunochemical testing (FIT) on colorectal cancer (CRC) diagnosis in NHS Tayside since its introduction in 2015.
- A review of cancer audit data from 2016 to 2019 showed that 75.7% of primary care patients diagnosed with CRC underwent FIT prior to referral, with an increase in FIT usage over the years.
- While FIT triage led to a higher rate of non-emergency presentations for CRC, it did not affect the stage at which the cancer was diagnosed.
Aim: The faecal immunochemical test (FIT) for faecal haemoglobin (f-Hb) helps determine the risk of colorectal cancer (CRC) and has been integrated into symptomatic referral pathways. 'Safety netting' advice includes considering referral for persistent symptoms, but no published data exists on repeated FITs. We aimed to examine the prevalence of serial FITs in primary care and CRC risk in these patients.
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- The study aimed to investigate how faecal haemoglobin (f-Hb) levels change between rounds of colorectal cancer (CRC) screening and how they relate to colonoscopy results in Scotland's bowel screening program.
- Researchers compared f-Hb concentrations and outcomes from the first and second rounds among participants with different initial test results, including negative and positive FIT results.
- Findings indicated that f-Hb levels varied depending on the test results from the first round, and having a negative colonoscopy does not completely rule out the possibility of significant pathology being found in subsequent screenings.
Background: Polypectomy may be performed at colonoscopy and then subsequent surveillance undertaken. It is thought that faecal haemoglobin concentration (f-Hb), estimated by quantitative faecal immunochemical tests (FIT), might be a useful tumour marker.
Methods: Consecutive patients enrolled in colonoscopy surveillance were approached at two hospitals.
Article Synopsis
- * Results revealed that women had a lower median faecal haemoglobin concentration (720 µg Hb/g) compared to men (473 µg Hb/g), and this difference was most significant for left-sided cancers and earlier stages of the disease.
- * The study suggests that to address these gender disparities, screening programs might consider using different faecal haemoglobin threshold levels for women and men.
Article Synopsis
- * The National Institute for Health and Care Excellence has identified key symptoms like rectal bleeding and iron deficiency anemia, but many cases yield low rates of CRC (only 2-3%) when assessed based solely on symptoms.
- * The faecal immunochemical test (FIT) is beneficial for GPs, as a negative result indicates a low risk of significant bowel disease, while a high f-Hb level requires immediate further investigation.
Article Synopsis
- Faecal haemoglobin concentration (f-Hb) is a useful tool in primary care for assessing the risk of colorectal cancer (CRC) in patients with lower gastrointestinal symptoms.
- *The study evaluated various f-Hb thresholds to determine when a patient can be reassured versus when they need further investigation, showing that lower thresholds allow for higher percentages of patients to be managed without additional procedures.
- *Overall, the findings suggest that measuring f-Hb, along with clinical evaluations, helps to make informed decisions about CRC risk and patient management in a primary care setting.
Article Synopsis
- Lower gastrointestinal symptoms are not very effective in predicting colorectal cancer (CRC), so this study evaluated how well faecal haemoglobin (f-Hb) levels predict CRC during colonoscopy for symptomatic patients.
- The study involved 4,841 patients in three Scottish NHS Boards, finding that only 0.6% of those with low f-Hb (<10 µg/g) were diagnosed with CRC, compared to 9.4% of those with f-Hb ≥10 µg/g and 22.4% with f-Hb ≥400 µg/g.
- The results suggest that patients with f-Hb ≥10 µg/g should be further investigated for CRC, while those with f-Hb <10 µ
Article Synopsis
- Colorectal cancer (CRC) rates have dropped for people over 50 in Scotland but have increased for those under 50, highlighting a worrying trend among younger populations.* -
- A study using data from the Scottish Cancer Registry and Bowel Screening Database found that participation in screening significantly reduced CRC rates in those aged 50-74, while rates for younger individuals continued to rise.* -
- Overall, while screening has helped decrease CRC incidence in older age groups, the rising incidence in younger individuals suggests the need for further investigation and potential intervention strategies.*
Article Synopsis
- * Among 1,447 patients, it was found that 20.5% were diagnosed with significant bowel disease (SBD) through colonoscopy; notably, most cases of SBD were in patients with higher fecal hemoglobin levels (≥10 g Hb/g feces).
- * The results suggest that patients with rectal bleeding and low fecal hemoglobin levels (<10 g Hb/g feces) are less likely to have serious bowel disease and could potentially be evaluated with a simpler sigmoidoscopy
Article Synopsis
- Faecal immunochemical tests for haemoglobin (FIT) are essential for colorectal cancer screening, guiding follow-up investigations based on faecal haemoglobin concentration (f-Hb) thresholds.
- A study analyzed f-Hb distributions among 887,248 screening participants in Scotland, revealing variations based on sex, age, deprivation levels, and geographical region.
- Findings indicated that f-Hb is consistently higher in men, increases with age and deprivation, and suggests the need for tailored investigation thresholds, contrasting with previous evaluations from other countries.
Article Synopsis
- The study compares faecal immunochemical tests (FIT) and guaiac faecal occult blood tests (FOBT) in colorectal cancer screening, revealing FIT's advantages in uptake and positivity rates among participants.
- FIT showed a higher uptake (63.9%) compared to FOBT (56.4%), but had a lower positive predictive value (PPV) for colorectal cancer (5.2% for FIT vs. 6.4% for FOBT) while having a higher PPV for higher-risk adenomas (24.3% for FIT vs. 19.3% for FOBT).
- The findings highlighted an unexpected 67.2% increase in colonoscopy demand with the FIT threshold, significantly
Article Synopsis
- The study evaluated the accuracy of faecal immunochemical tests (FIT) in detecting colorectal cancer (CRC) in high-risk patients undergoing surveillance colonoscopy.
- Out of 1103 patients invited, 639 completed the test, and some were found to have advanced neoplasia, revealing a significant correlation between detectable faecal haemoglobin (f-Hb) and the presence of neoplasia.
- The findings suggest that measuring f-Hb can effectively indicate risk levels for advanced neoplasia, potentially allowing for more personalized scheduling of colonoscopies in high-risk individuals.
Article Synopsis
- Many primary care patients have lower bowel symptoms, but serious bowel diseases like colorectal cancer and inflammatory bowel disease are rare; fecal immunochemical tests (FIT) help identify those who should get further colonoscopic evaluation.
- This study looked at data from a Scottish NHS Board to see if the FAST score, which includes fecal hemoglobin, age, and sex, improves decision-making for colonoscopy referrals based on FIT results from nearly 5,700 specimens collected in the first year.
- Results showed that while a significant number of patients with serious bowel disease had high fecal hemoglobin levels, using the FAST score could reduce referrals but risked missing some cases, highlighting a balance needed between sensitivity and practicality in screening.
Article Synopsis
- - The study aimed to determine the effectiveness of flexible sigmoidoscopy as an addition to traditional faecal occult blood test (FOBT) screening for colorectal cancer in individuals around age 60.
- - Conducted in Scotland with over 51,000 participants, the trial found that flexible sigmoidoscopy had a low uptake (17.8%), with higher rates in men and less in more deprived areas; however, it did detect more neoplasia compared to FOBT alone.
- - Results showed no difference in overall colorectal cancer detection between the two groups, but flexible sigmoidoscopy did significantly increase adenoma and total neoplasia detection rates, indicating it may be a beneficial complementary screening method.
Article Synopsis
- A study aimed to see if a faecal immunochemical test (FIT) for faecal haemoglobin (f-Hb) can be safely used in primary care to rule out serious bowel diseases like colorectal cancer (CRC) and inflammatory bowel disease (IBD).
- The research involved 5422 patients who submitted FIT samples, revealing a positivity rate of 21.9%, with 20.5% of those completing a colonoscopy having significant bowel disease.
- The findings suggest that f-Hb testing, alongside clinical evaluation, is an effective way to assess patients' risk for serious bowel diseases in a primary care setting.