Fecal Hemoglobin-Guided Precision Postpolypectomy Surveillance Within the Current Framework: A...

Area of Science:

• Gastroenterology and Hepatology
• Oncology
• Public Health and Epidemiology

Background:

• Optimizing post-polypectomy surveillance intervals is crucial for balancing colonoscopy resource allocation and colorectal cancer (CRC) risk reduction in fecal immunochemical test (FIT) screening programs.
• Current surveillance guidelines may not fully leverage individual risk stratification based on fecal hemoglobin (f-Hb) levels.

Purpose of the Study:

• To develop and evaluate fecal hemoglobin concentration (f-Hb)-guided precision surveillance intervals for individuals who have undergone polypectomy.
• To integrate these precision intervals into existing CRC screening frameworks to optimize colonoscopy utilization.

Main Methods:

• Analysis of data from 89,771 participants (aged 50-74) in a FIT screening program (2010-2015) with post-polypectomy and f-Hb ≥20 μg Hb/g, followed through 2018.
• Estimation of CRC risks using an accelerated failure time model based on f-Hb levels.
• Proportional adjustment of surveillance intervals: shortened for higher f-Hb, extended for lower f-Hb, and comparison with current U.S. guidelines.

Main Results:

• CRC incidence varied stepwise with f-Hb levels, from 2.2/1,000 person-years (PY) at 20-49 μg/g to 4.0/1,000 PY at ≥450 μg/g.
• Hypothetical f-Hb-guided intervals were lengthened for low-risk, low-f-Hb individuals and shortened for high-f-Hb individuals.
• Adoption of precision intervals could reduce colonoscopy demand by 9.8% compared to current guidelines, while maintaining comparable CRC risk.

Conclusions:

• Fecal hemoglobin-guided precision surveillance intervals offer a valuable adjunct to current guideline-based strategies.
• This precision approach enhances colonoscopy resource optimization within FIT-based CRC screening programs.
• The strategy preserves the established benefits of FIT screening for colorectal cancer risk reduction.