The yield of colorectal cancer among fast track patients with normocytic and microcytic anaemia.
BACKGROUND
We receive fast track referrals on the basis of iron deficiency anaemia (IDA) for patients with normocytic anaemia or for patients with no iron studies. This study examined the yield of colorectal cancer (CRC) among fast track patients to ascertain whether awaiting confirmation of IDA is necessary prior to performing bowel investigations.


METHODS
A review was undertaken of 321 and 930 consecutive fast track referrals from Centre A and Centre B respectively. Contingency tables were analysed using Fisher's exact test. Logistic regression analyses were performed to investigate significant predictors of CRC.


RESULTS
Overall, 229 patients were included from Centre A and 689 from Centre B. The odds ratio for microcytic anaemia versus normocytic anaemia in the outcome of CRC was 1.3 (95% confidence interval [CI]: 0.5-3.9) for Centre A and 1.6 (95% CI: 0.8-3.3) for Centre B. In a logistic regression analysis (Centre B only), no significant difference in CRC rates was seen between microcytic and normocytic anaemia (adjusted odds ratio: 1.9, 95% CI: 0.9-3.9). There was no statistically significant difference in the yield of CRC between microcytic and normocytic anaemia (p=0.515, Fisher's exact test) in patients with anaemia only and no colorectal symptoms. Finally, CRC cases were seen in both microcytic and normocytic groups with or without low ferritin.


CONCLUSIONS
There is no significant difference in the yield of CRC between fast track patients with microcytic and normocytic anaemia. This study provides insufficient evidence to support awaiting confirmation of IDA in fast track patients with normocytic anaemia prior to requesting bowel investigations.
Dorset County Hospital NHS Foundation Trust, UK.
I G
IG
Panagiotopoulou
D
D
Fitzrol
R A
RA
Parker
J
J
Kuzhively
N
N
Luscombe
A D
AD
Wells
M
M
Menon
F M
FM
Bajwa
M A
MA
Watson
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis / Q000209:etiology*; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000209:etiology; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D005293:Ferritins / Q000097:blood; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D061665:Time-to-Treatment
D005293:Ferritins