title: Faecal haemoglobin concentration is related to detection of advanced colorectal neoplasia in the next screening round.
abstract: Objective To examine associations between faecal haemoglobin concentrations below the cut-off used in colorectal cancer screening and outcomes in the next screening round. Methods In the Scottish Bowel Screening Programme, faecal haemoglobin concentrations and diagnostic outcomes were investigated for participants with a negative result (faecal haemoglobin concentrations < 80.0 µg Hb/g faeces), followed by a positive result within two years. Results Of 37,780 participants with negative results, at the next screening round, 556 (1.5%) screened positive and 30,293 (80.2%) negative. Initial median faecal haemoglobin concentrations (2.1 µg Hb/g faeces, IQR: 0.0-13.2) were higher in those with subsequent positive results than those with subsequent negative results (0.0 µg Hb/g faeces, IQR: 0.0-1.4; p < 0.0001). Using faecal haemoglobin concentrations 0.0-19.9 µg Hb/g faeces as reference, logistic regression analysis showed high adjusted odds ratios for advanced neoplasia (advanced neoplasia: colorectal cancer or higher risk adenoma) detection at the next round of 14.3 (95% CI: 8.9-23.1) in those with initial faecal haemoglobin concentrations 20.0-39.9 µg Hb/g faeces, and 38.0 (95% CI: 20.2-71.2) with 60.0-79.9 µg Hb/g faeces. Conclusions A higher proportion of participants with faecal haemoglobin concentrations of ≥ 20 µg Hb/g faeces had advanced neoplasia detected at the next round than participants with lower faecal haemoglobin concentrations. Although most relevant when using high faecal haemoglobin concentrations cut-offs, studies of faecal haemoglobin concentrations and outcomes over screening rounds may provide strategies to direct available colonoscopy towards those at highest risk.
authors.affiliation: 1 Scottish Bowel Screening Research Unit, Ninewells Hospital and Medical School, Dundee, Scotland.|2 Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, Dundee, Scotland.
authors.forename: Jayne
authors.initials: J
authors.lastname: Digby
authors.affiliation: 1 Scottish Bowel Screening Research Unit, Ninewells Hospital and Medical School, Dundee, Scotland.|2 Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, Dundee, Scotland.
authors.forename: Callum G
authors.initials: CG
authors.lastname: Fraser
authors.affiliation: 3 Department of Pathology, Ninewells Hospital and Medical School, Dundee, Scotland.
authors.forename: Francis A
authors.initials: FA
authors.lastname: Carey
authors.affiliation: 4 Department of Surgery, Crosshouse Hospital, Kilmarnock, Ayrshire, Scotland.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Diament
authors.affiliation: 5 Department of Pathology, Crosshouse Hospital, Kilmarnock, Ayrshire, Scotland.
authors.forename: Margaret
authors.initials: M
authors.lastname: Balsitis
authors.affiliation: 1 Scottish Bowel Screening Research Unit, Ninewells Hospital and Medical School, Dundee, Scotland.|2 Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, Dundee, Scotland.|6 Medical Research Institute, Division of Cancer, Ninewells Hospital and Medical School, Scotland.
authors.forename: Robert Jc
authors.initials: RJ
authors.lastname: Steele
mesh_terms: D000236:Adenoma / Q000097:blood* / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000465:Algorithms; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000097:blood* / Q000175:diagnosis; D055088:Early Detection of Cancer / Q000379:methods*; D005243:Feces / Q000737:chemistry*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D016017:Odds Ratio; D010865:Pilot Projects; D012044:Regression Analysis; D012606:Scotland; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins
keywords: Advanced neoplasia; colorectal cancer; faecal haemoglobin; faecal immunochemical test; faecal occult blood test; risk; screening