A new insight into fecal hemoglobin concentration‐dependent predictor for colorectal neoplasia

Abstract

We sought to assess how much of the variation in incidence of colorectal neoplasia is explained by baseline fecal hemoglobin concentration (FHbC) and also to assess the additional predictive value of conventional risk factors. We enrolled subjects aged 40 years and over who attended screening for colorectal cancer with the fecal immunochemical test (FIT) in Keelung community-based integrated screening program. The accelerated failure time model was used to train the clinical weights of covariates in the prediction model. Datasets from two external communities were used for external validation. The area under curve (AUC) for the model containing only FHbC was 83.0% (95% CI: 81.5-84.4%), which was considerably greater than the one containing only conventional risk factors (65.8%, 95% CI: 64.2-67.4%). Adding conventional risk factors did not make significant additional contribution (p 5 0.62, AUC 5 83.5%, 95% CI: 82.1-84.9%) to the predictive model with FHbC only. Males showed a stronger linear dose-response relationship than females, yielding gender-specific FHbC predictive models. External validation confirms these results. The high predictive ability supported by a dose-dependent relationship between baseline FHbC and the risk of developing colorectal neoplasia suggests that FHbC may be useful for identifying cases requiring closer postdiagnosis clinical surveillance as well as being an early indicator of colorectal neoplasia risk in the general population. Our findings may also make contribution to the development of the FHbC-guided screening policy but its pros and cons in connection with cost and effectiveness of screening should be evaluated before it can be applied to population-based screening for colorectal cancer.While the fecal immunochemical test (FIT) is widely used in population-based screening for colorectal neoplasia and is effective in reducing colorectal cancer mortality through early detection, 1-12 it has been not yet known whether the detailed information on quantitative fecal hemoglobin concentration (FHbC) available with the FIT might also be of use for predicting the risk of colorectal neoplasia. Unfortunately, because clinical practice is to select subjects with FHbC greater than a set cut-off for further clinical investigation the precise value of FHbC, although measured and often reported, is largely neglected. The previous study reported that baseline FHbC can be predictive of incident colorectal neoplasia among screening participants who test negative at the first screen. 13 Nonetheless, it is not possible to fully investigate the relationship between risk of developing colorectal neoplasia and having a high FHbC because the natural history of the disease in those with FHbC levels above the cut off is interrupted owing to the administration of medical regime. To assess the predictive power of FHbC as a measure of risk of colorectal neoplasia one must develop a risk model based on FHbC (measured as a continuous variable at baseline in those testing both negative and positive according t...

Faecal haemoglobin concentration and personalised assessment of the risk of colorectal neoplasia

“…This work has been subsequently extended and f-Hb has been demonstrated to be an independent predictor of the risk of colorectal neoplasia (12). In Scotland, it has been documented that f-Hb is related to detection of AN in the next screening round and it was clearly stated that studies of f-Hb and outcomes over screening rounds might provide strategies to direct available colonoscopy towards those at highest risk (13).…”

The association between fecal hemoglobin concentration and oral potentially malignant disorders

“…While fecal immunochemical test (FIT) has become an early detection method for colorectal cancer in population‐based screening program (Benson et al, ) with the axiom that the concentration of fecal hemoglobin (f‐Hb), one kind of antibody to human hemoglobin, can be detected from feces in an quantitative manner. There are three previous studies demonstrating the dose‐response effects of f‐Hb on the risk of incident neoplasia (Chen, Yen, Chiu, Liao, & Chen, ; Yen et al, ) and to colorectal cancer (CRC) mortality (Chen et al, ). The recent two studies also found the positive associations between f‐Hb concentration and periodontal probing depth (Amy, Lai, Fann, Chiu, & Chen, ), and also inflammatory bowel disease (Kato, Hiraoka, & Nakarai, ), which is a chronic inflammation disorders of the intestine (Rubin, Shaker, & Levin, ).…”

FIT for the future: a case for risk‐based colorectal cancer screening using the faecal immunochemical test

“…Studies that incorporate risk assessment into the screening algorithm show the potential for improved test accuracy of the FIT . For example, Stegeman et al .…”

“…Studies that incorporate risk assessment into the screening algorithm show the potential for improved test accuracy of the FIT [8,[16][17][18]. For example, Stegeman et al investigated combining risk factors with the FIT result when selecting individuals for colonoscopy referral in a Dutch population [16].…”