Age-stratified colonoscopy outcomes and referral-factor associations in the Swedish colorectal cancer fast-track pathway: a retrospective cohort study
Abdullah Jajan, Michiel van NieuwenhovenBackground:
The standardised course of care colorectal cancer pathway (SCC-CRC) is a symptom-based fast-track diagnostic pathway. Age-related differences in outcomes and referral-factor associations within different age groups are incompletely described.
Objective:
To describe colonoscopy outcomes across age groups in SCC-CRC and evaluate unadjusted and adjusted associations between referral factors and CRC and advanced colorectal lesions.
Design:
A retrospective cohort study.
Methods:
A cohort of 3258 patients referred through SCC-CRC and investigated with colonoscopy during 2016–2023 was grouped by age (18–40, 41–50, 51–60, 61–70, 71–80, >80 years). Referral factors were analysed using positive predictive value (PPVs), sensitivity, specificity, likelihood ratios and logistic regression adjusted for age, sex and coexisting referral factors; a second model included faecal immunochemical test (FIT) among patients with available FIT data.™
Results:
CRC was detected in 0% of patients aged 18–40, 6.5% aged 41–50, 11.2% aged 51–60, 18.3% aged 61–70, 18.1% aged 71–80 and 21.2% aged >80. The frequency of referral factors varied across age groups, while the PPV for CRC increased with age. Rectal and radiological findings were associated with CRC across age groups. In adjusted analysis without FIT, radiological findings, rectal findings, anaemia and visible blood were independently associated with CRC. Among patients with FIT data, positive FIT was strongly associated with CRC and negative FIT had a high negative predictive value.
Conclusion:
CRC detection increased with age in this symptomatic cohort. Several referral factors were independently associated with CRC, but PPV increased with age, partly because CRC prevalence increased with age. Routine FIT testing in SCC-CRC referrals and complete FIT data capture should be assessed in future studies.