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Updated: Jun 16, 2025
Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
Published on: June 8, 2020
Systematic review: Mortality associated with raised faecal immunochemical test and positive faecal occult blood
Francesca Ligori Malcolm1, Anjali K D S Yapa1, Zhen Yu Wong1
1Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
Background:
Faecal haemoglobin (f-Hb) testing is used in colorectal cancer (CRC) screening and increasingly to guide the investigation in patients with symptoms suggestive of CRC. Studies have demonstrated increased mortality with raised f-Hb.
Aims:
To assess the association of raised f-Hb with all-cause, non-CRC (any cause excluding CRC) and cause-specific mortality.
Methods:
We searched Medline and Embase on 9 February 2024 to identify papers reporting mortality after faecal immunochemical (FIT) or guaiac faecal occult blood tests (gFOBT). The primary outcome was all-cause mortality following a positive compared to a negative test.
Results:
The search identified 3155 papers. Ten met the inclusion criteria: three reported gFOBT and seven reported FIT results, as screening tests. These reported a total of 14,687,625 f-Hb results. Elevated f-Hb was associated with an increased risk of all-cause, non-CRC and cause-specific mortality including death from cardiovascular, digestive and respiratory diseases. Crude risk ratios for all-cause mortality with a positive versus negative test were derived from six papers (three reporting gFOBT, three FIT). An increased risk was demonstrated in five, with RRs ranging from 1.11 (95% CI: 1.06-1.16) to 2.95 (95% CI: 2.85-3.05). For non-CRC mortality risk, RRs ranged from 1.09 (95% CI: 1.04-1.15) to 2.79 (95% CI: 2.70-2.89). We did not perform meta-analysis due to a limited number of papers reporting suitable results for each type of f-Hb test.
Conclusions:
All-cause, non-CRC and cause-specific mortality appear higher in those with raised f-Hb. Population-based studies are warranted to elicit whether this association occurs in symptomatic patients.
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