Baseline faecal occult blood concentration as a predictor of incident colorectal neoplasia: longitudinal follow-up of a Taiwanese population-based colorectal cancer screening cohort

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

“…It may also lead to greater uptake at subsequent screens in those who tested negative at the first screen, as reported in a previous study. 13 The risk prediction model developed in our study has several merits. First, our study was a longitudinal followup study, which provides convincing evidence of a causal relationship.…”

“…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 to the FIT) in addition to conventional risk factors.…”

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

“…Faecal haemoglobin concentration and personalised assessment of the risk of colorectal neoplasia f-Hb concentration and risk Some time ago now, it was shown by Chen et al that f-Hb at first screening predicts subsequent risk of incident colorectal neoplasia and it was suggested that, during follow-up, risk stratification based on f-Hb could help clinicians, with particular attention being paid to those with higher initial f-Hb, especially those just under the f-Hb cut-off applied (11). This work has been subsequently extended and f-Hb has been demonstrated to be an independent predictor of the risk of colorectal neoplasia (12).…”

Faecal haemoglobin concentrations vary with sex and age, but data are not transferable across geography for colorectal cancer screening

“…The specimen collection tubes were assayed, generally on the day of receipt, in the Scottish Bowel Screening Centre Laboratory, on one of two Eiken OCSensor Diana analysers. In Taiwan [12,13,16], the population aged 40-79 years comprised of two cohorts who had been offered population-based screening for CRC using FIT as part of the comprehensive community-based integrated screening programme: the first were residents of Keelung city, which is situated in the North of Taiwan, and the second resided in Tainan county, which is situated in the far South. The single specimens obtained were assayed using OC-Sensor methodology (Eiken Chemical Company Ltd) in a central laboratory.…”

“…There is also considerable evidence that f-Hb increases as disease becomes more serious, from the normal to low-risk adenomatous polyps, then to higher-risk polyps and then to cancer, although there is much overlap between these groups [8,9]. Further, there is growing realisation that f-Hb alone, or in combination with other important factors [10,11], can be used to predict future risk: Chen et al investigated f-Hb as a predictor of incident colorectal neoplasia [12] and found that, in participants with f-Hb below the usual f-Hb cut-off used for referral for colonoscopy, the subsequent risk of incident colorectal neoplasia was predicted. Recently, this work has been extended and it has been shown that f-Hb is related to CRC mortality and even to all-cause death [13].…”