Risk for detecting CRC up to 13-times higher with fecal hemoglobin in prior negative FIT
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Key takeaways:
- Individuals with fecal hemoglobin concentrations of 5 µg/g to 40 µg/g had a 5- to 13-fold higher risk for colorectal neoplasia.
- Concentrations were “especially predictive” of advanced neoplasia.
The risk for detecting colorectal neoplasia at a subsequent screening increased by up to 13-fold relative to fecal hemoglobin concentrations in previous negative fecal immunochemical tests, according to research.
“Prior studies have shown that individuals with an [fecal hemoglobin (f-Hb)] value just below the cutoff have an increased CRC risk compared to individuals with no f-Hb or very low concentrations,” Danica M. N. van den Berg, a PhD candidate in the department of public health at Erasmus MC, and colleagues wrote in Gastroenterology. “Given the established association between f-Hb and CRC risk, risk-stratifying CRC screening programs based on quantitative FIT values could potentially improve the harm-benefit ratio of CRC screening.”
They continued, “Accurate risk assessment plays a crucial role in tailoring screening strategies to individuals, as misclassification of individuals into risk groups can lead to two potential issues: over- or underscreening.”
To investigate the association between prior f-Hb concentrations and the detection of colorectal neoplasia, van den Berg and colleagues conducted a systematic review and dose-response meta-analysis of 13 studies, which included 4,493,223 individuals at average risk for CRC.
According to the researchers, there was “a large variability” in f-Hb positivity cutoffs in the studies, which ranged from 10 µg f-Hb/g to 80 µg f-Hb/g, the most common of which was 20 µg f-Hb/g. There also was a significant positive association in the studies between f-Hb in the previous screening and the detection of colorectal neoplasia, with a pooled effect size of 0.69 (95% CI, 0.59-0.79).
When using an f-Hb reference concentration of 0 µg/g, the researchers reported that individuals with concentrations of 5 µg/g, 10 µg/g, 15 µg/g, 20 µg/g and 40 µg/g had 3.4-, 5.2-, 6.8-, 8.2- and 13-fold higher risk for colorectal neoplasia, respectively. The largest risk increase was observed between 0 µg/g and 10 µg/g, after which it decreased with rising concentrations. These results were confirmed via sensitivity analysis, with a significant, high heterogeneity (i2 = 97.5%; P < .001).
Subgroup analyses also showed that the risk associated with rising f-Hb concentrations varied by outcome and was “especially predictive” for the detection of advanced neoplasia at the next screening.
“The risk of detecting colorectal neoplasia increases with f-Hb concentrations in prior FIT, but the rate of increase diminishes as f-Hb levels rise,” van den Berg and colleagues wrote. “These findings support the potential for risk-stratified CRC screening programs based on quantitative FIT values to improve the effectiveness of screening and optimize the harm-benefit ratio.”
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