Review Article Almost Half of Patients Referred to Fast Track 2-Week Clinics had Previous Colonic Imaging and A 0.94% Risk of Having Bowel Cancer
by MR Thompson1*, KG Flashman2, LG D’Cruz2
1Department of Surgery, Queen Alexandra Hospital Portsmouth UK 2Research Innovation Department, Queen Alexandra Hospital Portsmouth UK
*Corresponding author: Thompson MR, Colorectal Unit, Surgical Department, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
Received Date: 19 February2025
Accepted Date: 28 February 2025
Published Date: 03 March 2025.
Citation: Thompson MR, Flashman KG, D’Cruz LG (2025) Almost Half of Patients Referred to Fast Track 2-Week Clinics had Previous Colonic Imaging and A 0.94% Risk of Having Bowel Cancer. J Dig Dis Hepatol 10: 221. https://doi.org/10.29011/2574-3511.100221
Abstract
Introduction: This study compared the risk of bowel cancer in patients referred to fast-track clinics according to whether or not they had previous colonic imaging. Method: A prospective audit of 1158 consecutive fast track referrals from November 2018 to February 2020. Results: 46% (530/1158) of referralsto 2-week clinics, who had previous colonic imaging, had a significantly lower risk of cancer 0.94% (5/530) v 4.9% (31/628) (P<0.05), than in patients not having previous imaging(p=0.0002, χ2=13.9, df=1). Five cancers occurring despite previous imaging were diagnosed 4,5,7,16 and 30 yrs after the first examination. As three had iron deficiency anaemia (IDA), diagnostic yield in patients having previous imaging within the last 17 years, without IDA, was 0.2%(1/475). None of the five cancers were in the rectum, compared to 48%(15/31) in patients not having colonic imaging, and more survived 2-3 years after surgery 80%(4/5) v 52%(16/31). Diagnostic yield of polyps >9mm in size was 1.9% (10/530) (p<0.001) compared to 5.6% (35/628) in patients not having colonic imaging (p=0.002, χ2= 9.49, df=1). Previous colonic imaging was within the last 12 months in 24 patients, and 156 had more than one previous examination. Conclusion: Almost half of patients referred to two-week clinics had previous colonic imaging, mostly just flexible sigmoidoscopy. These patients had a risk of cancer close to that of patients without symptoms, and well below the NICE 3% threshold of risk, meriting referral to these clinics. Low prevalence of bowel cancer in these patients is likely due to previous detection and removal of significant distal adenomatous polyps.
Keywords:Bowel Cancer; Colonic imaging; Patient.
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