A NEW systematic review and meta-analysis of 13 studies, involving over 4.4 million participants, highlights a significant link between elevated faecal haemoglobin (f-Hb) levels in previous screenings and an increased risk of colorectal neoplasia. Colorectal cancer (CRC) risk is known to be higher in individuals with f-Hb concentrations just below the positivity threshold, but this study takes a closer look at the dose-response relationship to refine screening recommendations.
The pooled data revealed that individuals with f-Hb concentrations of 5, 10, 20, and 40 μg/g faced a 3-, 5-, 8-, and 13-fold higher risk of developing colorectal neoplasia, respectively, compared to those with 0 μg/g f-Hb. These findings suggest a clear gradient of risk based on prior f-Hb levels, underlining the importance of refining screening approaches based on past results.
Despite significant variability in study results, sensitivity analyses confirmed the robustness of the association. Subgroup analysis also indicated that higher f-Hb levels from negative tests were especially predictive of advanced neoplasia in follow-up screenings.
The results support the development of risk-based screening strategies, encouraging more tailored and targeted approaches to colorectal cancer detection. By focusing on individuals with higher f-Hb concentrations in prior screenings, healthcare providers can better identify those at greater risk for developing advanced neoplasia, potentially improving early detection and outcomes in CRC screening.
Helena Bradbury, EMJ
Reference
Van den Berg DMN et al. Fecal hemoglobin levels in prior negative screening and detection of colorectal neoplasia: a dose-response meta-analysis. Gastroenterology. 2024;S0016-5085(24)05748-2.
