PTU-099 Patients referred with anaemia should be investigated for cancer regardless of iron status

Introduction Patients referred under the 2-week wait (2WW) pathway for gastrointestinal cancer with iron deficiency anaemia (IDA) are investigated in our centre with colonoscopy, upper GI endoscopy and CT scanning; it is necessary to justify these investigations given the burden they place upon radiology and endoscopy services. Our aim was to examine the predictive role of ferritin in such referrals and to assess whether this might be used to better streamline investigations. Methods Referrals to the upper and lower GI cancer pathway over a period of one year were screened for referrals made exclusively for IDA. Data was collected on ferritin level, age, gender, cancer detection and modality of cancer detection. Low ferritin was defined as Results 3669 referrals to the upper and lower GI cancer pathway between May 2017 and May 2018 were screened for inclusion. 199 patients were referred exclusively for IDA of which 35 (17.5%) were found to have a malignancy. This compares to a local colorectal cancer detection rate of 5.0% for all referrals to the lower GI pathway. 119 patients (59.8%) had a low ferritin. There was no statistically significant difference between rate of cancer detection in the low and normal ferritin groups (16.8% vs 20% p=0.572). These cancers included several non-GI malignancies in both low ferritin and normal ferritin groups (5/20 vs 8/15, p=0.157) (See table 1). Males were more likely to have a cancer detected than females (26.1% vs 10.3%, p= 0.005). CT scanning missed the malignancy 6 cases of colorectal cancer subsequently detected on colonoscopy. Only 2 cancers were detected using upper GI endoscopy and both of these had been visible on CT scanning. Conclusions This study demonstrated a high rate of cancer detection for anaemia referrals but there was no correlation between ferritin level and detection of cancer. Ferritin may not be a helpful marker in screening anaemia referrals. These results support our current practice of investigations however future studies could seek to validate the role of upper GI endoscopy in these referrals.