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Faecal haemoglobin concentration predicts all-cause mortality.

Ulrik Deding1, Lasse Kaalby1, Robert Steele2

  • 1Department of Surgery, Odense University Hospital, Svendborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.

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|March 8, 2023
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Summary

Even low levels of fecal hemoglobin detected by screening tests indicate increased colorectal cancer and all-cause mortality risk. This highlights the importance of monitoring fecal immunochemical test (FIT) results for comprehensive health assessment.

Keywords:
All-cause mortalityColonoscopyColorectal cancerColorectal cancer mortalityFITFaecal immunochemical testScreening

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Area of Science:

  • Gastroenterology
  • Oncology
  • Public Health
  • Epidemiology

Background:

  • European Union recommends population-based colorectal cancer screening using faecal immunochemical test (FIT).
  • Detectable faecal haemoglobin in FIT can signify colorectal neoplasia or other conditions.
  • Positive FIT results correlate with increased colorectal cancer mortality and potentially all-cause mortality.

Purpose of the Study:

  • To investigate the association between varying faecal immunochemical test (FIT) concentrations and colorectal cancer specific mortality.
  • To assess the relationship between FIT concentrations and all-cause mortality in a screening population.
  • To determine if mortality risks are elevated even at FIT levels considered negative by current European screening standards.

Main Methods:

  • A cohort of 444,910 Danish screening participants was followed using national death registers.
  • Data included FIT concentrations and causes of death, linked via the Danish Colorectal Cancer Screening Database.
  • Multivariate Cox proportional hazards regression models compared mortality risks across different FIT concentration groups.

Main Results:

  • A significant increase in colorectal cancer mortality risk was observed with rising FIT concentrations (hazard ratios 2.6–25.9 for FIT ≥ 4 μg Hb/g).
  • All-cause mortality risk also increased with higher FIT concentrations (hazard ratios 1.6–5.3 for FIT ≥ 4 μg Hb/g).
  • Elevated risks for both colorectal cancer and all-cause mortality were evident even at FIT concentrations of 4-9 μg Hb/g.

Conclusions:

  • Increasing faecal haemoglobin levels detected by FIT are strongly associated with elevated colorectal cancer mortality.
  • Detectable faecal blood, even at low concentrations (4-9 μg Hb/g), is linked to increased all-cause mortality.
  • These findings suggest that FIT results, even those below thresholds for current screening programs, provide valuable prognostic information.