title: Sex is a stronger predictor of colorectal adenoma and advanced adenoma than fecal occult blood test.
abstract: 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.
authors.affiliation: Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Freyung 6, 1010, Vienna, Austria, monika.ferlitsch@meduniwien.ac.at.
authors.forename: Monika
authors.initials: M
authors.lastname: Ferlitsch
authors.forename: Georg
authors.initials: G
authors.lastname: Heinze
authors.forename: Petra
authors.initials: P
authors.lastname: Salzl
authors.forename: Martha
authors.initials: M
authors.lastname: Britto-Arias
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Waldmann
authors.forename: Karoline
authors.initials: K
authors.lastname: Reinhart
authors.forename: Christina
authors.initials: C
authors.lastname: Bannert
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fasching
authors.forename: Peter
authors.initials: P
authors.lastname: Knoflach
authors.forename: Werner
authors.initials: W
authors.lastname: Weiss
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
authors.forename: Arnulf
authors.initials: A
authors.lastname: Ferlitsch
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D003111:Colonic Polyps; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D016017:Odds Ratio; D012737:Sex Factors