Allison, M.C.; Edwards, A.G.K.; Paling, S.; Penney, M.D.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA28
Academic Journal
Background: Most patients with proximal colonic cancer have iron deficiency anaemia at presentation. Therefore, measurement of serum iron and stores could prove a potential adjunct to faecal occult blood testing (FOBT) in screening and early detection of colorectal neoplasia. Methods: From a general practice serving 6677 in November 2000 we identified 1331 subjects aged 55-74 years. Of these 86 were excluded (comorbidity, previous colorectal cancer or inflammatory bowel disease and/or already undergoing endoscopic surveillance and/or investigation of established iron deficiency during the previous 3 years). Thus, 1240 subjects were mailed to explain the study and invite them to the surgery. After obtaining consent, blood was taken for serum iron, iron saturation, and ferritin. Those with iron saturation < 10% and/or ferritin < 15 µg/I were invited to see their GP for history and physical examination, plus FOBT, blood count and coeliac serology, and offered hospital referral for consultation, gastroscopy and colonoscopy. Results: There were 23 subjects who had recently died or moved away. Of the remaining 1217 subjects 570 (47%) have so far come forward for venepuncture. Iron deficiency was detected in 26 of these (5%), of whom 24 agreed to hospital referral and 18 consented to endoscopic investigation. One had a large sessile adenoma requiring right hemicolectomy and another had 5 pedunculated sigmoid polyps. One patient was found to have coeliac disease. Erosive oesophagitis, gastric erosions, and angiodysplasia were each found in two patients. Just before the study 2 patients from the practice (aged 56 and 73) were diagnosed with iron deficiency anaemia due to colorectal cancer, both of whom would have been detected by the study had it started 3 months sooner. Conclusions: Screening middle aged and older subjects for iron deficiency in primary care is feasible, and is accepted by 47%, which compares favourably with studies using FOBT. Clinically...


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