title: Non-neoplastic findings at colonoscopy after positive faecal occult blood testing: data from the English Bowel Cancer Screening Programme.
abstract: BACKGROUND
  The aim of the English Bowel Cancer Screening Programme (BCSP) is to diagnose early colorectal cancer and advanced adenomas. However, other findings are also reported at screening colonoscopy. Small studies demonstrate findings other than cancer or adenomas (non-neoplastic findings (NNF)) in 11-25%.
  
  
  OBJECTIVE
  Describe the frequency and nature of NNF within the BSCP.
  
  
  METHODS
  Data were obtained from the BCSP national database for all individuals undergoing colonoscopic investigation after positive faecal occult blood testing between August 2006 and November 2011. Data included demographics, smoking status, neoplastic findings and NNF.
  
  
  RESULTS
  121728 colonoscopies were analysed. ≥1 NNF were found in 26251 cases (21.6%). Diverticular disease (18875 cases) and haemorrhoids (7011) were the most frequently reported. Inflammatory bowel disease (IBD) was reported in 2152 cases. Individuals with a neoplastic diagnosis were less likely to have an NNF than those without (19.8% v 24.4%, p < 0.001). After adjustment for confounding using multivariable analysis, older age was still associated with a small but statistically significant risk of NNF.
  
  
  CONCLUSIONS
  The BCSP generates a significant volume of NNF. A small proportion of individuals were found to have inflammatory bowel disease (IBD) - an important diagnosis with implications for long-term management. BCSP participants should be aware that findings other than neoplasia may be detected and the relevance of these findings to that individual is not known. Reporting of NNF varies between colonoscopists, and potential underreporting is a limitation of this study. Further study is required to establish the impact of NNF on primary and secondary care.
authors.affiliation: Northern Region Endoscopy Group South Tyneside District Hospital, South Shields.
authors.forename: Roisin
authors.initials: R
authors.lastname: Bevan
authors.affiliation: Northern Region Endoscopy Group North Tyneside District Hospital, North Shields.
authors.forename: Thomas J W
authors.initials: TJ
authors.lastname: Lee
authors.affiliation: NHS Cancer Screening Programmes, Sheffield.
authors.forename: Claire
authors.initials: C
authors.lastname: Nickerson
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, County Durham.
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
authors.affiliation: Northern Region Endoscopy Group South Tyneside District Hospital, South Shields School of Medicine, Pharmacy and Health, Durham University, County Durham colin.rees@stft.nhs.uk.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Rees
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D006138:Guaiac; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D011237:Predictive Value of Tests; D011933:Reagent Kits, Diagnostic / Q000592:standards*
chemical_list: D011933:Reagent Kits, Diagnostic; D006138:Guaiac
keywords: colonoscopy; colorectal cancer screening; faecal occult blood testing; non-neoplastic findings