It can be difficult to detect colorectal cancer. A faecal test that reveals traces of blood in the feces can guide the GP in the diagnostic process, concludes new PhD thesis from Aarhus University

2018.03.03 | Dorthe Toftdahl Nielsen

Jakob Søgaard Juul defends his PhD thesis about diagnosing bowel cancer in general practice using a fecal blood test at Friday, March 16, 2018 at Aarhus University (photo: Lars Kruse, AU Foto).

Most cases of colorectal cancer are diagnosed by the GP after the introduction of the screening program for colorectal cancer in 2014. One of the major challenges is that approximately half of the patients present vague and non-specific symptoms that do not make the doctor suspect cancer. This makes it difficult for the doctor to detect the cancer in time.

PhD fellow, MD Jakob Juul Søgaard has in a new health science PhD project from Aarhus University examined whether the faecal test FIT, which can identify traces of invisible blood, can be used by the GP in the diagnostic process of these patients. The project has been completed at the Research Centre for Cancer Diagnosis in Primary Cancer (CaP), the Research Unit for General Practice, Department of Public Health, Aarhus University.

The test detects cancer in early stages

As a part of the project, GPs in the Central Denmark Region were given the opportunity to use the faecal immunochemical test (FIT) on patients with vague and non-specific symptoms of colorectal cancer. After the project period, the dissemination and use of the test among the GPs were investigated, as well as the diagnostic value of the test in the diagnostic process of the patients.

The results show that most GPs began to use the test as a regular part of the diagnostic tools. Participation in a brief teaching session on the use of FIT in general practice had a positive effect on getting the GPs to start using the test. However, it did not influence how often the doctor used the test.

Of persons with a positive faecal test, approximately 10% had colorectal cancer and another 15% had other severe bowel diseases (inflammatory bowel disease and high risk adenomas). Of the diagnosed intestinal cancer cases, approximately 2/3 were found in early stages (stages I and II) which has the best option for treatment.

The faecal test appears to be a useful tool for diagnosing colorectal cancer and other serious bowel diseases - especially those who come to the doctor with symptoms not referred to as actual 'alarm' symptoms. The test can be used as an indicator of the need for further examination.

Defence on 16 March 2018

The PhD dissertation and the three related scientific articles origins from the Health Faculty at Aarhus University. The project was conducted in close collaboration between the Research Centre for Cancer Diagnosis in Primary Care (CaP) at Aarhus University, the Research Unit for General Practice in Aarhus and GPs in the Central Denmark Region. The project received support from the Danish Cancer Society, the Central Denmark Region and the Quality and Continuing Education Committee in the Central Denmark Region.

Jakob Søgaard Juul defends his PhD thesis "Using the faecal immunochemical test in general practice: diagnostic workup of patients with non-alarm symptoms of colorectal cancer" Friday, March 16^th, 2018 at 2pm. 

Further information

PhD fellow Jakob Søgaard Juul
Aarhus University, Department of Public Health
The Research Unit for General Practice & Research Centre for Cancer Diagnosis in Primary Care (CaP)
Phone: +45 61 77 74 04
Email: j.juul@ph.au.dk

The three related scientific articles of the PhD Dissertation:

• Differences in diagnostic activity in general practice and findings for individuals invited to the Danish Screening Programme for colorectal cancer: a population-based cohort study: This study examines the diagnostic activity in general practice, as well as the cumulative incidence of colon cancer for persons invited to participate in the Danish Screening Program for Colon Cancer. The article has been submitted for publication.

• Clinical uptake and use of faecal immunochemical test after implementation in Danish general practice:  In this study, it is examined whether GPs started using FIT after the test was implemented in general practice and if participation in a short supplementary training influenced the use of the test. The article has been submitted for publication.
  
  
• Diagnostic value of using the faecal immunochemical test in general practice on patients presenting with non-alarm symptoms of colorectal cancer: article examines the number of bowel cancer diagnoses and other serious bowel diseases that were diagnosed after using FIT. In addition, the probability that the patient is diagnosed with a type of bowel cancer is estimated when the test is positive. The article has been submitted for publication.