A Taipei Medical University research team found that the hemoglobin concentration levels resulting from fecal occult blood tests (FOBT) can predict the risk and mortality of colorectal cancer, and could be used to suggest the interval between screenings.
The research team was led by the university’s College of Oral Medicine associate dean Sam Chen (陳立昇) and Amy Yen (嚴明芳), and the study was published in May in JAMA Oncology, a monthly peer-reviewed medical journal.
Colorectal cancer was the third leading cause of cancer deaths in Taiwan last year, Chen said, adding that government-funded FOBT is offered every two years to people aged 50 to 74 for routine screening of colorectal cancer.
Photo courtesy of the Hsinchu County Government
The cohort study included data from more than 3.5 million people who received the FOBT from 2004 and 2014, and followed up until 2019. It analyzed the data to study the relationship between fecal hemoglobin concentration and colorectal tumors, and death from colorectal cancer.
Chen said they found that increasing fecal hemoglobin concentration levels indicate more colorectal tumors and higher colorectal cancer mortality risk, allowing for stratification of risk groups, and can be used for calibrating suitable screening intervals.
Usually, a hemoglobin concentration level above 20mcg/g is considered positive, with a higher risk of cancer and requiring a colonoscopy follow-up, he said.
About half of those who had a positive FOBT result were detected to have polyps in a colonoscopy follow-up, while about 20 percent had progressive polyps, and about 5 percent had colorectal cancer, he said.
Chen said their study found that fecal hemoglobin concentration levels can be used to more accurately assess colorectal cancer risk and mortality rates, and to personalize screening intervals, with shorter intervals for higher fecal hemoglobin levels.
The biennial FOBT has been proven to reduce the risk of late-stage colorectal cancer by 29 percent and the risk of colorectal cancer death by 35 percent, he said.
Their findings further demonstrated how to achieve precision inter-screening intervals for optimizing the use of FOBT and colonoscopy, he said.
With personalized fecal hemoglobin concentration screening, FOBTs can be reduced by 49 percent and colonoscopies by 28 percent, he said, adding that this could optimize medical resources, and reduce unnecessary testing and risks while ensuring that high-risk groups get necessary testing and treatment promptly.
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