F-Hb Concentration at FIT May Help Define Screening Interval

TOPLINE:

A patient’s fecal hemoglobin concentration (f-Hb) on a fecal immunochemical test (FIT) could help determine their optimal screening interval for colorectal cancer (CRC).

METHODOLOGY:

• Researchers analyzed a dose-response association between f-Hb concentrations and the presence of any advanced neoplasia (ie, advanced adenoma or CRC) in an ongoing study of colonoscopy screening in Germany.

• The analysis evaluated data from 7398 men and women aged 50-80 years, after exclusion of younger and older patients, those with a history of CRC or inflammatory bowel disease, and those with other colonoscopy factors.

• Participants underwent a quantitative FIT (FOB Gold; Sentinel Diagnostics) before screening colonoscopy and were grouped by f-Hb concentration (µg/g of feces):

• Subgroup analyses were done by sex and age within the f-Hb categories.

• Adenomas ≥ 1 cm, those with (tubulo-)villous components, and high-grade dysplasia were considered advanced.

TAKEAWAY:

• Overall, 41% of participants had f-Hb concentrations 17 µg/g.

• The prevalence of advanced neoplasia increased from 6% among people with f-Hb concentrations 17 µg/g).

• In overall diagnostic accuracy, at a cutoff of 17 µg/g, positivity was 9.9%, sensitivity and positive predictive value were 39%, and specificity and negative predictive value were 93%.

IN PRACTICE:

The findings “indicate that those in the upper range of negative FIT values are at higher risk for CRC than those in the lower range,” the authors write. “Despite increased complexity, this suggests a benefit from personalized screening intervals.”

SOURCE:

The study was led by Tobias Niedermaier, PhD, German Cancer Research Center, Heidelberg, and was published online on November 7 in the Annals of Internal Medicine.

LIMITATIONS:

Limitations include limited generalizability to other FIT brands and other populations, statistical power, and the cross-sectional design.

DISCLOSURES:

The study was funded by grants from the German Research Council, the Federal Ministry of Education and Research, and German Cancer Aid. The authors reported no disclosures of interest.

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Cite this: F-Hb Concentration at FIT May Help Define Screening Interval – Medscape – Nov 16, 2023.