Screening program detects more colorectal cancers in adults with diabetes
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Key takeaways:
- Random screening for colorectal cancer with fecal immunochemical tests detected more cases at earlier stages than not screening.
- More cases were detected among adults with diabetes than those without.
A colorectal cancer screening program in Denmark that used fecal immunochemical testing detected more cases among adults with diabetes and more cases at stage I of the disease than among those without diabetes, according to data published in Diabetic Medicine.
“Diabetes is associated with a 20% higher risk of developing colorectal cancer,” Tinne Laurberg, MD, PhD, a pathologist at Steno Diabetes Center Aarhus at Aarhus University Hospital in Denmark, told Healio. “Fecal immunochemical testing may be an effective tool to detect colorectal cancer at early disease stages, especially in individuals with diabetes.”
Laurberg and colleagues conducted a registry-based cohort study of adults aged 50 to 74 years with no prior colorectal cancer diagnosis who were invited to take part in a Danish national colorectal cancer screening program. Adults who were invited to participate from March 2014 to May 2016 were placed into an invited group, whereas those who had not been invited by May 2016 were placed in an uninvited group. Data on colorectal cancer diagnosis were obtained from the Danish Colorectal Cancer Group Database. Five Danish nationwide health registries were used to collect data on the cohort. Adults were considered to have diabetes if they were diagnosed with type 1 or type 2 diabetes at the time of their screening invitation or at a randomly selected date for those who were in the not invited group.
The study included 1,054,032 adults, of whom 549,359 (mean age, 63.8 years) were invited to participate in colorectal cancer screening and 504,673 (mean age, 63.3 years) were not invited. Of the study cohort, 10.2% had diabetes at the data of invitation, with the not invited group having a slightly higher diabetes prevalence than the invited group (10.4% vs. 9.9%; P < .001).
The screening program increased the number of detected cancers by 217 cases from 147 per 100,000 individuals to 364 per 100,000. Among those with diabetes, the number of detected cancers increased by 287 cases from 207 per 100,000 individuals to 494 per 100,000 individuals. Being invited to screening more than doubled the risk for being diagnosed with colorectal cancer compared with those who were not invited, with the relative risk similar between adults with diabetes (RR = 2.39; 95% CI, 1.92-2.97) and those without diabetes (RR = 2.48; 95% CI, 2.27-2.7). Of adults diagnosed with cancer, a higher proportion was observed in the invited group at a stage I cancer than the not invited group (24% vs. 14%; P < .001).
Of all adults invited to the screening program, 67% participated. Among those diagnosed with cancer, the prevalence of stage III or stage IV cancer was higher among nonparticipants with diabetes than participants with diabetes (60% vs. 28%). More adults without diabetes participated in screening than those with diabetes (68.2% vs. 59%). Adults with type 1 diabetes had a slightly higher participation rate than those with type 2 diabetes (61.5% vs. 58.9%).
“Only about 50% of the people with diabetes participated in the national colorectal cancer screening program,” Laurberg said. “Further studies is needed to investigate how to improve adherence to the program for those with diabetes and thereby obtain better effects of the screening efforts.”
For more information:
Tinne Laurberg, MD, PhD, can be reached at tinlaurb@rm.dk.
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