Hemoglobin Concentration Is Related to Risk for Colorectal Neoplasia, Even in People with Negative FIT

Summary and Comment |
August 7, 2017

Hemoglobin Concentration Is Related to Risk for Colorectal Neoplasia, Even in People with Negative FIT

  1. Douglas K. Rex, MD

Actual hemoglobin results from fecal immunochemical testing could be used to better risk stratify patients but are currently not reported to U.S. clinicians.

  1. Douglas K. Rex, MD

It is well known that higher concentrations of hemoglobin (Hgb) in stool are associated with a greater risk for colorectal cancer. In the United States, fecal immunochemical test (FIT) results are reported only as positive or negative, based on the cut-off level selected. The Multi-Society Task Force on Colorectal Cancer recommends a cut-off of 20 µg Hgb/g feces. Higher cut-offs are associated with lower sensitivity, higher specificity, and higher positive-predictive value.

In the current study, Dutch investigators used a cut-off of 10 µg Hgb/g feces in examining the long-term risk for advanced neoplasia among approximately 7500 screened residents whose FIT tests were negative (<10 µg Hgb/g feces), according to the amount of Hgb in the stool. At 5 years after the baseline FIT, those with an Hgb concentration of 8 to 10 µg/g had an eightfold higher risk for advanced neoplasia compared with those with 0 µg/g (33% vs. 5%), with a gradient of risk for intermediate concentrations.

Comment

These results suggest that a considerable amount of useful clinical information, which could potentially be used to stratify FIT screening intervals, is available in the actual quantitative result, but this information is hidden from view to American clinicians because the test is reported as only positive or negative.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Editor Disclosures at Time of Publication

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant/Advisory board Olympus Corporation America; Boston Scientific Speaker’s bureau Boston Scientific Grant/Research support Medtronic; Boston Scientific; Colonary Solutions; Paion Medical; Medivators; Braintree Laboratories Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology; GI Journal Watch; Austin Journal of Gastroenterology; World Journal of Gastrointestinal Pharmacology & Therapeutics Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Force (AGA, ACG, ASGE) (Chair)

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