Effects of Oral Anticoagulants and Aspirin on Performance of Fecal Immunochemical Tests in Colorectal Cancer Screening

Kristin Ranheim Randel; Edoardo Botteri; Katrine Maria Kauczynska Romstad; Svein Oskar Frigstad; Michael Bretthauer; Geir Hoff; Thomas de Lange; Øyvind Holme

doi:10.1053/j.gastro.2019.01.040

Effects of Oral Anticoagulants and Aspirin on Performance of Fecal Immunochemical Tests in Colorectal Cancer Screening

Gastroenterology. 2019 May;156(6):1642-1649.e1. doi: 10.1053/j.gastro.2019.01.040. Epub 2019 Jan 25.

Authors

Kristin Ranheim Randel¹, Edoardo Botteri², Katrine Maria Kauczynska Romstad³, Svein Oskar Frigstad⁴, Michael Bretthauer⁵, Geir Hoff⁶, Thomas de Lange⁷, Øyvind Holme⁸

Affiliations

¹ Department of Research and Development, Telemark Hospital, Skien, Norway; Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Department of Medicine, Ostfold Hospital Trust, Grålum, Norway. Electronic address: Kristin.Ranheim.Randel@cancerregistry.no.
² Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Norwegian National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway.
³ Institute of Clinical Medicine, University of Oslo, Norway; Department of Medicine, Ostfold Hospital Trust, Grålum, Norway.
⁴ Institute of Clinical Medicine, University of Oslo, Norway; Department of Medicine, Vestre Viken Bærum Hospital, Gjettum, Norway.
⁵ Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Norway; Frontier Science Foundation, Boston, Massachusetts; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
⁶ Department of Research and Development, Telemark Hospital, Skien, Norway; Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
⁷ Institute of Clinical Medicine, University of Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
⁸ Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Norway; Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway.

PMID: 30689972
DOI: 10.1053/j.gastro.2019.01.040

Abstract

Background & aims: The fecal immunochemical test (FIT) is the tool most frequently used for colorectal cancer (CRC) screening worldwide. It is unclear how the use of aspirin and oral anticoagulants in the screening population affects the diagnostic performance of FIT.

Methods: We performed a cross-sectional study in an ongoing CRC screening trial in Norway. Participants aged 50-74 years with a positive result from an FIT (>15 μg hemoglobin/g feces) and subsequent colonoscopy (reference standard) were included. Those who used regular aspirin, warfarin, or direct-acting oral anticoagulants (DOACs) were defined as users. Non-users were matched according to age, sex, screening center, and screening round. The primary outcomes were the positive predictive value (PPV) for CRC and advanced adenoma.

Results: Among 4908 eligible participants, 1008 used aspirin, 147 used warfarin, 212 used DOACs, and 3541 were non-users. CRCs were found in 234 individuals and advanced adenomas in 1305 individuals. The PPV for CRC was 3.8% for aspirin users vs 6.4% for matched non-users (P = .006), The PPV for advanced adenoma in aspirin users was 27.2% vs 32.6% for matched non-users (P = .011). For DOAC, the PPV for CRC was 0.9% in users vs 6.8% in matched non-users (P = .001). The PPV for advanced adenoma in DOAC users was 20.5% vs 32.4% in matched non-users (P = .002). There was no significant difference in PPV for CRC or advanced adenoma in warfarin users compared to non-users.

Conclusions: In a large screening cohort in Norway, regular use of aspirin and particularly DOACs, were associated with lower PPV of FIT for detection of CRCs and advanced adenomas. ClinicalTrials.gov ID NCT01538550.

Keywords: Acetyl Salicylic Acid; Colorectal Neoplasia; Immunochemical Fecal Occult Blood Test.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenoma / diagnosis*
Administration, Oral
Aged
Anticoagulants / administration & dosage*
Aspirin / administration & dosage*
Colonoscopy
Colorectal Neoplasms / diagnosis*
Cross-Sectional Studies
Early Detection of Cancer / methods*
Female
Humans
Immunochemistry
Male
Middle Aged
Occult Blood*
Platelet Aggregation Inhibitors / administration & dosage*
Predictive Value of Tests
Warfarin / administration & dosage

Substances

Anticoagulants
Platelet Aggregation Inhibitors
Warfarin
Aspirin

Associated data

ClinicalTrials.gov/NCT01538550