title: Fecal hemoglobin concentration as a measure of risk to tailor colorectal cancer screening: are we there yet?
abstract: The aim of this paper was to examine the distribution of fecal hemoglobin (f-Hb) concentration in a Spanish colorectal cancer screening population according to sociodemographic characteristics and analyze whether f-Hb was associated with clinical outcomes (type of lesion and its location). From September 2009 to November 2012, we sent 77,744 invitations to individuals aged 50-69 years to provide one sample of feces. f-Hb was measured on samples from 27,606 screenees (35.5%). Colonoscopy findings and pathology data were collected on the 1406 screenees with f-Hb greater than 100 ng Hb/ml (20 mg Hb/g feces). The Mann-Whitney U-test and the Kruskal-Wallis test were used to compare f-Hb (median) according to sociodemographic variables, clinical outcomes, and histological features of adenomas. f-Hb from greater than 100 ng Hb/ml was categorized into quartiles. Regression models were used to determine whether f-Hb was a risk predictor of colorectal lesions. f-Hb was associated directly with the severity of the colorectal lesions. An overlap between individuals with a negative colonoscopy and those with a low-risk adenoma was observed. High-grade dysplasia, villous histology, distal location, and increasing size were all features associated with an increased f-Hb level. f-Hb could be used in individual risk assessment to determine surveillance strategies for colorectal cancer screening.
authors.affiliation: aCancer Prevention and Control Program bPharmacy Department, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat Departments of cFundamental Care and Medical-Surgical Nursing dClinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Garcia
authors.forename: Núria
authors.initials: N
authors.lastname: Milà
authors.forename: Gemma
authors.initials: G
authors.lastname: Binefa
authors.forename: Llúcia
authors.initials: L
authors.lastname: Benito
authors.forename: Núria
authors.initials: N
authors.lastname: Gonzalo
authors.forename: Víctor
authors.initials: V
authors.lastname: Moreno
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology; D015331:Cohort Studies; D003106:Colon / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods*; D005243:Feces / Q000737:chemistry*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007120:Immunochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009780:Occult Blood; D012007:Rectum / Q000473:pathology
chemical_list: D006454:Hemoglobins