title: Risk stratification for advanced colorectal neoplasia according to fecal hemoglobin concentration in a colorectal cancer screening program.
abstract: OBJECTIVE
  The latest generation of fecal immunochemical tests (FIT) allows for quantitation of hemoglobin in feces, allowing for selection of optimal cut-off concentrations. We investigated whether individuals with positive results from quantitative FITs, in combination with other factors, could be identified as being at greatest risk for advanced colorectal neoplasia.
  
  
  METHODS
  In a retrospective study, we analyzed data from a consecutive series of 3109 participants with positive results from FITs (≥20 μg/g of feces) included in the first round of the Barcelona colorectal cancer screening program, from December 2009 through February 2012. All participants underwent colonoscopy and were assigned to groups with any advanced colorectal neoplasia or with nonadvanced colorectal neoplasia (but with another diagnosis or normal examination findings).
  
  
  RESULTS
  Median fecal hemoglobin concentrations were significantly higher in participants with advanced colorectal neoplasia (105 μg/g; interquartile range, 38-288 μg/g) compared with participants with nonadvanced colorectal neoplasia (47 μg/g; interquartile range, 23-119 μg/g) (P < .001). Positive predictive values for advanced colorectal neoplasia, determined using arbitrary fecal hemoglobin concentrations, differed with sex and age. Multivariate logistic regression analysis identified sex (men: odds ratio [OR], 2.07; 95% confidence interval, 1.78-2.41), age (60-69 y: OR, 1.24; 95% confidence interval, 1.07-1.44), and fecal hemoglobin concentration (>177 μg/g: OR, 3.80; 95% confidence interval, 3.07-4.71) as independent predictive factors for advanced colorectal neoplasia. Combining these factors, we identified 16 risk categories associated with different probabilities of identifying advanced colorectal neoplasia. Risk for advanced colorectal neoplasia increased 11.46-fold among individuals in the highest category compared with the lowest category; positive predictive values ranged from 21.3% to 75.6%.
  
  
  CONCLUSIONS
  Fecal hemoglobin concentration, in addition to sex and age, in individuals with positive results from FITs can be used to stratify probability for the detection of advanced colorectal neoplasia. These factors should be used to prioritize individuals for colonoscopy examination.
authors.affiliation: Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain. Electronic address: jmauge@clinic.cat.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Auge
authors.affiliation: Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Pellise
authors.affiliation: Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Escudero
authors.affiliation: Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: Gastroenterology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Andreu
authors.affiliation: Preventive Medicine and Hospital Epidemiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Grau
authors.affiliation: Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Buron
authors.affiliation: Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: López-Cerón
authors.affiliation: Gastroenterology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bessa
authors.affiliation: Preventive Medicine and Hospital Epidemiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Serradesanferm
authors.affiliation: Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Mercè
authors.initials: M
authors.lastname: Piracés
authors.affiliation: Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Macià
authors.affiliation: Council of Colleges of Pharmacists in Catalonia, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Guayta
authors.affiliation: Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Filella
authors.affiliation: Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Molina
authors.affiliation: Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain.
authors.forename: Wladimiro
authors.initials: W
authors.lastname: Jimenez
authors.affiliation: Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Castells
mesh_terms: D000367:Age Factors; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000737:chemistry* / Q000473:pathology; D055088:Early Detection of Cancer; D005243:Feces / Q000737:chemistry*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007120:Immunochemistry; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009780:Occult Blood; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain
chemical_list: D014408:Biomarkers, Tumor; D006454:Hemoglobins
keywords: Colonoscopy; Colorectal Cancer Screening; Fecal Immunochemical Tests; Risk Stratification