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

Defining precision postpolypectomy surveillance intervals is essential to optimize the balance between colonoscopy resource use and colorectal cancer (CRC) risk reduction within population-based fecal immunochemical test (FIT) screening programs. We sought to develop fecal hemoglobin (f-Hb) concentration-guided surveillance intervals and integrate them into the existing surveillance framework.

Between 2010 and 2015, 3,929,387 individuals participated in FIT screening, of whom 89,771 participants aged 50 to 74 years with f-Hb ≥20 μg Hb/g and complete colonoscopy after polypectomy were enrolled and monitored through 2018 for ascertaining incident CRCs. CRC risks across different f-Hb concentrations were estimated using an accelerated failure time model, and surveillance intervals were proportionally adjusted-shortened at higher f-Hb and extended at lower levels. We compared pragmatic, precision-oriented surveillance intervals with current guidelines to evaluate the extent of colonoscopy reduction without compromising CRC risk.

There were 89,771 postpolypectomy individuals stratified as high-risk (49.5%) and low-risk (50.5%) groups based on the United States surveillance guideline. During a mean 5.5-year follow-up, CRC incidence was 2.8/1000 person-years (95% confidence interval, 2.7-3.0), increasing stepwise from 2.2/1000 person-years at 20 to 49 μg/g to 4.0/1000 person-years at ≥450 μg/g. Hypothetical f-Hb-guided surveillance intervals were lengthened for low-risk individuals with low f-Hb and shortened for those with elevated f-Hb within both risk categories. If adopting this precision approach, colonoscopy demand could be reduced by 9.8% vs current United States guidelines, while maintaining comparable CRC risk.

Precision surveillance intervals guided by f-Hb can complement current guideline-based strategies by optimizing colonoscopy resource use while preserving the benefits of FIT-based CRC screening programs.