Most US veterans with anemia, hematochezia do not undergo testing for early-onset CRC
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Key takeaways:
- Women and Black and Hispanic veterans with anemia were less likely to complete diagnostic testing for early age-onset CRC.
- Hispanic veterans with hematochezia were also less likely to undergo testing.
Diagnostic test completion for early age-onset colorectal cancer is low among U.S. veterans presenting with iron-deficiency anemia or hematochezia, with women and Black and Hispanic veterans less likely to undergo follow-up testing.
“This investigation was the follow-up to a prior study within the Veterans Health Administration looking at the association between iron-deficiency anemia or hematochezia and early-onset CRC risk in veterans younger than 50,” Joshua Demb, PhD, MPH, a postdoctoral scholar at UC San Diego Moores Cancer Center and health science research specialist at VA San Diego Health Care, told Healio. “In that study, we found that having either of these symptoms was associated with a nearly tenfold increased risk of early-onset CRC, but that very few veterans were receiving colonoscopy within 5 years of presenting with these symptoms.”
In a retrospective cohort study, Demb and colleagues evaluated diagnostic test completion rates among 3,728,118 U.S. veterans aged 18 to 49 years within the Veterans Health Administration between 1999 and 2019. The primary outcome was time to diagnostic testing, with completion defined as bidirectional endoscopy for veterans with iron-deficiency anemia (IDA) and either colonoscopy or sigmoidoscopy for those with hematochezia.
According to results published in JAMA Network Open, 59,169 veterans had a diagnosis of IDA (mean age, 40.7 years; 51.6% men), 189,185 had a diagnosis of hematochezia (mean age, 39.4 years; 86.5% men) and 2,287 had a diagnosis of both (mean age, 41.6 years; 81.2% men).
“The biggest takeaway from this study was that diagnostic test completion after presenting with IDA or hematochezia was low,” Demb said. “Specifically, only 22% of those with IDA, 44% of those with hematochezia and 56% with both symptoms received diagnostic testing within 2 years that would be consistent with U.S.-based guidelines for these age groups.”
Further, women with IDA (RR = 0.42; 95% CI, 0.4-0.43) had a lower likelihood of diagnostic test completion compared with men, as did Black (RR = 0.65; 95% CI, 0.62-0.68) and Hispanic (RR = 0.88; 95% CI, 0.82-0.94) veterans compared with white veterans.
Among those with hematochezia, veterans aged 30 to 49 years were more likely to undergo diagnostic testing compared with veterans younger than 30 years (aged 30-39 years: RR = 1.15; 95% CI, 1.12-1.18; aged 40-49 years: RR = 1.36; 95% CI, 1.33-1.4), while Hispanic veterans were less likely to undergo diagnostic testing compared with their white counterparts (RR = 0.96; 95% CI, 0.93-0.98).
“The findings from this study build upon the prior study to create a clear message: Adults younger than 50 presenting with IDA or hematochezia, who are at increased risk of early onset CRC, should be examined further to rule out more serious conditions,” Demb told Healio.
“The findings of disparities in diagnostic test completion also underscore the importance of developing equitable diagnostic follow-up patterns, to avoid creating worse sex-specific and race- and ethnicity-specific disparities in CRC-specific outcomes.”
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