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A novel blood based triage test for colorectal cancer in primary care: a pilot study

Cerys Jenkins, Freya Woods, Susan Chandler, Kym Carter, Rhys Jenkins, Andrew Cunningham, Kayleigh Nelson, Rachel Still, Jenna A Walters, Non Gwynn, Wilson Chea, Rachel Harford, Claire O'Neill, Julie Hepburn, Ian Hill, Heather Wilkes, Greg Fegan, Peter Dunstan Orcid Logo, Dean Harris Orcid Logo

BJGP Open, Volume: 7, Issue: 1, Start page: BJGPO.2022.0077

Swansea University Authors: Peter Dunstan Orcid Logo, Dean Harris Orcid Logo

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Abstract

Background: The majority of colorectal cancers (CRCs) are detected after symptomatic presentation to primary care. Given the shared symptoms of CRC and benign disorders, it is challenging to manage the risk of missed diagnosis. Colonoscopy resources cannot keep pace with increasing demand. There is...

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Published in: BJGP Open
ISSN: 2398-3795
Published: Royal College of General Practitioners 2023
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa63168
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Abstract: Background: The majority of colorectal cancers (CRCs) are detected after symptomatic presentation to primary care. Given the shared symptoms of CRC and benign disorders, it is challenging to manage the risk of missed diagnosis. Colonoscopy resources cannot keep pace with increasing demand. There is a pressing need for access to simple triage tools in primary care to help prioritise patients for referral. Aim: To evaluate the performance of a novel spectroscopy-based CRC blood test in primary care. Design & setting: Mixed-methods pilot study of test performance and GP focus group discussions in South Wales. Method: Patients on the urgent suspected cancer (USC) pathway were recruited for the Raman spectroscopy (RS) test coupled to machine learning classification (‘Raman-CRC’) to identify CRC within the referred population. Qualitative focus group work evaluated the acceptability of the test in primary care by thematic analysis of focus group theorising. Results: A total of 532 patients aged ≥50 years referred on the USC pathway were recruited from 27 GP practices. Twenty-nine patients (5.0%) were diagnosed with CRC. Raman-CRC identified CRC with sensitivity 95.7%, specificity 69.3% with area under curve (AUC) of 0.80 compared with colonoscopy as the reference test (248 patients). Stage I and II cancers were detected with 78.6% sensitivity. Focus group themes underlined the convenience of a blood test for the patient and the test’s value as a risk assessment tool in primary care. Conclusion: The findings support this novel, non-invasive, blood-based method to prioritise those patients most likely to have CRC. Raman-CRC may accelerate access to diagnosis with potential to improve cancer outcomes.
Keywords: colorectal neoplasms, two-week waitpilot projects, qualitative research, Raman spectroscopy, primary health care, general practice
College: Faculty of Science and Engineering
Issue: 1
Start Page: BJGPO.2022.0077