Beyond age and family history: Symptoms as predictors in colorectal cancer screening

Abstract

Colorectal cancer (CRC) screening guidelines have prioritized age and clinically relevant family history, yet other clinically relevant parameters remain underutilized. Our study investigates the correlation between CRC-related manifestations and screening performance metrics—polyp detection rate (PDR) and adenoma detection rate (ADR). This cross-sectional retrospective study analyzed 235,781 colonoscopy procedures from eight medical centers in Israel conducted between 2016 and 2022. The dataset comprised the identification and classification of polyps, adenomas, and CRC, in conjunction with patient demographics, clinical background, and particular clinical-laboratory manifestations, including hematochezia, abdominal pain, family history of CRC, fecal occult blood results, and presence of anemia. Our study found significant variations in PDR and ADR based on symptom presence. Patients with hematochezia exhibited a PDR of 36.8% and an ADR of 12.1%, compared to 28.7% and 10.8% in those without it. Furthermore, individuals with occult blood in their feces had a PDR of 48.3% and an ADR of 21.5%, respectively, while those without had rates of 31.6% and 11.0%. In addition, having a family history of CRC is also related to a more significant increase in PDR and ADR of 37.7% and 13.8% compared to patients with no family history of CRC, who had PDR and ADR of 33.3% and 12.2%. Moreover, clinical combinations, including CRC family history with hematochezia or occult blood, had the highest PDR of 62.3% and 58.9%, and ADR of 15% and 20.6%, respectively. Incorporating hematochezia and fecal blood occult tests enhances the effectiveness of the CRC screening.