CRC screening based on fecal hemoglobin levels could reduce other testing by up to 49%

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Key takeaways:

  • Higher fecal hemoglobin concentrations at baseline suggest a shorter repeat screening interval.
  • Screening interval could be extended to 3 and 4 years among those with levels of 1 to 9 µg/g and 10 to 19 µg/g.

Using fecal hemoglobin concentrations to guide colorectal cancer screening intervals reduced the number of fecal immunochemical tests and colonoscopies by 49% and 28%, respectively, compared with biennial screening, data showed.

“Several studies using data from population-based CRC screening with FIT demonstrated a gradient relationship between fecal hemoglobin (f-Hb) concentrations and the incidence of CRC, colorectal neoplasms and CRC mortality,” Amy Ming-Fang Yen, PhD, of Taipei Medical University, and colleagues wrote in JAMA Oncology. “Such empirical findings underscore the potential of finetuning the use of quantitative f-Hb measurements as a means to devise individualized interscreening intervals for FIT-based CRC screening regimens.”

Graphic depicting rates of colorectal cancer per 1,000 person-years.

Data derived from: Yen AMF, et al. JAMA Oncol. 2024;doi:10.1001/jamaoncol.2024.0961.

In a retrospective cohort study, Yen and colleagues used data from 3,500,250 participants aged 50 to 74 years (mean age, 57.8 years) enrolled in a Taiwanese biennial nationwide FIT screening program to assess the gradient association between f-Hb levels and risk for CRC incidence and mortality. Researchers categorized participants by f-Hb concentration: undetectable, 1 to 9 µg/g, 10 to 19 µg/g, 20 to 49 µg/g, 50 to 99 µg/g, 100 to 149 µg/g and 150 µg/g or more.

According to study results, an incremental increase in baseline f-Hb correlated with a heightened risk for CRC. Participants with undetectable f-Hb at baseline had a CRC incidence rate of 0.94 per 1,000 person-years vs. 10.25 per 1,000 person-years for those with a baseline f-Hb of at least 150 µg/g. Researchers noted a similar trend for the incidence of advanced CRC, which ranged from 8.68 per 1,000 person-years to 45.2 per 1,000 person-years, respectively.

Further, results showed that increasing f-Hb concentrations, which “strongly suggest” an increased risk for CRC mortality, can be used to inform screening intervals.

According to researchers, using 20 to 49 µg/g as the standard screening interval, participants with a higher f-Hb concentration at initial screening should undergo “confirmatory examinations with highly intensive surveillance,” while those with a lower concentration at baseline could lengthen the interval between repeated FIT screenings to prevent false-positive results. Screening interval could be extended to 3 and 4 years among those with f-Hb levels of 1 to 9 µg/g and 10 to 19 µg/g.

These proposed f-Hb-guided screening intervals could reduce the number of FIT tests and colonoscopies by 49% and 28% vs. a universal biennial screening strategy, researchers wrote.

“The findings of this study not only confirmed the previous gradient relationship between f-Hb levels and incidence and mortality, on which we have based distinct proposals for personalized screening paradigms,” Yen and colleagues wrote. “Using f-Hb, we demonstrated how to achieve precision interscreening interval of population-based FIT screening for optimizing the use of FIT and colonoscopies.”

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