Faecal haemoglobin concentration is related to severity of colorectal neoplasia

TY - JOUR

T1 - Faecal haemoglobin concentration is related to severity of colorectal neoplasia

AU - Digby, Jayne

AU - Fraser, Callum G.

AU - Carey, Francis A.

AU - McDonald, Paula J.

AU - Strachan, Judith A.

AU - Diament, Robert H.

AU - Balsitis, Margaret

AU - Steele, Robert J. C.

PY - 2013

Y1 - 2013

N2 - Aims Guaiac faecal occult blood tests are being replaced by faecal immunochemical tests (FIT). We investigated whether faecal haemoglobin concentration (f-Hb) was related to stage in progression of colorectal neoplasia, studying cancer and adenoma characteristics in an evaluation of quantitative FIT as a first-line screening test.Methods We invited 66 225 individuals aged 50-74 years to provide one sample of faeces. f-Hb was measured on samples from 38 720 responders. Colonoscopy findings and pathology data were collected on the 943 with f-Hb >= 400 ng Hb/ml (80 mu g Hb/g faeces).Results Of the 814 participants with outcome data (median age: 63 years, range 50-75, 56.4% male), 39 had cancer, 190 high-risk adenoma (HRA, defined as >= 3 or any >= 10 mm) and 119 low-risk adenoma (LRA). 74.4% of those with cancer had nf-Hb> 1000 ng Hb/ml compared with 58.4% with HRA, and 44.1% with no pathology. Median f-Hb concentration was higher in those with cancer than those with no (p10 mm) compared with small adenoma (pConclusions f-Hb is related to severity of colorectal neoplastic disease. This has ramifications for the selection of the appropriate cut-off concentration adopted for bowel screening programmes.

AB - Aims Guaiac faecal occult blood tests are being replaced by faecal immunochemical tests (FIT). We investigated whether faecal haemoglobin concentration (f-Hb) was related to stage in progression of colorectal neoplasia, studying cancer and adenoma characteristics in an evaluation of quantitative FIT as a first-line screening test.Methods We invited 66 225 individuals aged 50-74 years to provide one sample of faeces. f-Hb was measured on samples from 38 720 responders. Colonoscopy findings and pathology data were collected on the 943 with f-Hb >= 400 ng Hb/ml (80 mu g Hb/g faeces).Results Of the 814 participants with outcome data (median age: 63 years, range 50-75, 56.4% male), 39 had cancer, 190 high-risk adenoma (HRA, defined as >= 3 or any >= 10 mm) and 119 low-risk adenoma (LRA). 74.4% of those with cancer had nf-Hb> 1000 ng Hb/ml compared with 58.4% with HRA, and 44.1% with no pathology. Median f-Hb concentration was higher in those with cancer than those with no (p10 mm) compared with small adenoma (pConclusions f-Hb is related to severity of colorectal neoplastic disease. This has ramifications for the selection of the appropriate cut-off concentration adopted for bowel screening programmes.

KW - 3 ROUNDS

KW - PROGRAM

KW - TESTS

KW - OCCULT BLOOD-TEST

KW - CANCER SCREENING PILOT

KW - PERFORMANCE

U2 - 10.1136/jclinpath-2013-201445

DO - 10.1136/jclinpath-2013-201445

M3 - Article

C2 - 23418340

SN - 0021-9746

VL - 66

SP - 415

EP - 419

JO - Journal of Clinical Pathology

JF - Journal of Clinical Pathology

IS - 5

ER -