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Occult blood in feces linked to death risk beyond colorectal cancer
The presence of occult blood in feces is associated with increased risk of death from a number of causes in addition to colorectal cancer, according to research published in Gut.
Robert J.C. Steele, professor of surgery at Ninewells Hospital and Medical School, and colleagues wrote that the presence of fecal occult blood could offer patients an early warning about potential, but reversible, diseases.
“A test result positive for blood in feces confers a high risk of harboring and perhaps developing either CRC or its precursor lesion, an adenoma, and it follows that an asymptomatic population of individuals with positive [fecal occult blood test] results have a higher risk of CRC mortality than those who have negative results,” they wrote. “A similar association with all-cause mortality was observed and this trend persisted after exclusion of all CRC deaths suggesting that the presence of [hemoglobin] in feces could be a predictor of life expectancy independent from its association with CRC.”
Steele and colleagues analyzed data from Scottish patients who underwent occult blood screening between 2000 and 2016 (n = 134,192). They linked tests results with mortality data from the National Records of Scotland database to determine the risk of death associated with positive test results.
After adjusting for gender, age, deprivation and medication that can cause bleeding, investigators found that patients with a positive test had a higher risk of dying from CRC than those without a positive result (HR = 7.79; 95% CI, 6.13–9.89).
Patients with a positive result also had a more than 50% higher risk of death for non-CRC (HR = 1.58; 95% CI, 1.45–1.73). The presence of occult blood was associated with increased risk of dying from circulatory disease, respiratory disease, digestive diseases excluding CRC, neuropsychological disease, blood and endocrine disease and non-CRC.
Steele and colleagues wrote that their findings could have a number of implications. According to them, hemoglobin found in feces might have potential as a biomarker to assess the efficacy of lifestyle and medical interventions to reduce the risk of premature death. Even if cancer isn’t found following a positive result, fecal occult blood tests could alert patients about the risk of reversible diseases.
“To fully explore the significance of the presence of [hemoglobin] in feces, it will be necessary to carry out prospective population-based studies of [fecal hemoglobin] concentration using quantitative [fecal immunochemical tests] to assess its association with lifestyle (including diet), health status and medication,” the researchers wrote. “It will then be necessary to carry out studies to examine the hypothesis that [fecal hemoglobin] concentration might be used as a meaningful index of the success of life-prolonging interventions based on, for example, diet, weight management, exercise or medication.” – by Alex Young
Disclosures: Steele reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.