Sex is a stronger predictor of colorectal adenoma and advanced adenoma than fecal occult blood test

• Published in: Medical oncology (Northwood, London, England) Vol. 31; no. 9; p. 151
• Main Authors: Ferlitsch, Monika, Heinze, Georg, Salzl, Petra, Britto-Arias, Martha, Waldmann, Elisabeth, Reinhart, Karoline, Bannert, Christina, Fasching, Elisabeth, Knoflach, Peter, Weiss, Werner, Trauner, Michael, Ferlitsch, Arnulf
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.09.2014; Springer Nature B.V
• Subjects: Adenoma - diagnosis; Adenoma - epidemiology; Adenoma - physiopathology; Aged; Aged, 80 and over; Austria - epidemiology; Colonic Polyps; Colonoscopy; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - physiopathology; Early Detection of Cancer; Female; Hematology; Humans; Internal Medicine; Male; Mass Screening; Medicine; Medicine & Public Health; Middle Aged; Occult Blood; Odds Ratio; Oncology; Original Paper; Pathology; Sex Factors; Austria; Adenoma detection rate; Advanced adenoma detection rate; Fecal occult blood test; Screening colonoscopy
• ISSN: 1357-0560; 1559-131X
• DOI: 10.1007/s12032-014-0151-0

Due to high costs and limited availability of screening colonoscopy, some screening programs require a positive fecal occult blood test (FOBT) before screening colonoscopy is remunerated. As male sex is a strong predictor of adenoma and advanced adenoma, we evaluated whether a positive FOBT or male sex is a stronger risk factor for adenoma and advanced adenoma. FOBT and screening colonoscopy results from 18.665 consecutive patients participating in a “national health check program” between 2009 and 2011 were included in this cohort study. Age-corrected adenoma detection rates (ADR), advanced adenoma detection rates (AADR) and carcinoma detection rates were calculated for men and women according to FOBT result separately. ADR and AADR in FOBT-positive men (34.6 and 11.8 %) and FOBT-negative men (29.1 and 7.6 %) were higher than ADR and AADR in FOBT-positive women (20 and 6.9 %) and in FOBT-negative women (17.6 and 4.4 %), ( p  = 0.0003). Men with negative FOBT were at higher risk of having an adenoma and advanced adenoma than women with positive FOBT ( p  < 0.0001). Odds ratios of a positive FOBT for ADR and AADR were 1.3 (1.1–1.5) ( p  = 0.0047) and 1.6 (1.2–2.1) ( p  < 0.0001), respectively. Odds ratios of male sex to predict ADR and AADR were significantly higher with 1.9 (1.8–2.1) and 1.8 (1.6–2), respectively ( p  < 0.001). Male sex is a stronger predictor for colorectal adenoma and advanced adenoma than positive FOBT. These results should be taken into account analyzing FOBT-based screening programs.