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TOPLINE:

In a Taiwanese fecal immunochemical test (FIT) screening program, higher fecal hemoglobin (f-Hb) concentrations consistently predicted a greater risk for colorectal cancer (CRC) after polypectomy, and modelling showed that an f‑Hb‑guided strategy could reduce colonoscopy demand by 9.8% over 9 years while maintaining a comparable projected risk for CRC.

METHODOLOGY:

• Monitoring after polyp removal lowers the risk for CRC by detecting new growths early, but it often finds no serious problems in people at a low risk for CRC, and in some instances, cancers still appear after colonoscopy. Growing evidence suggests that f-Hb levels predict the residual risk for CRC and could be used to personalize surveillance while optimizing colonoscopy use.
• Researchers tested the precision of f-Hb-guided surveillance in a Taiwanese cohort of 89,771 individuals aged 50-74 years (63% men) who underwent colonoscopy and polypectomy after a positive FIT result (≥ 20 μg Hb per gram of feces) between 2010 and 2015.
• Participants were classified into low-risk (n = 45,377) and high-risk (n = 44,394) groups using United States Multi-Society Task Force (USMSTF) guideline criteria based on adenoma characteristics such as size, histology, and number.
• The time-to-event outcome of interest was the time from polypectomy to the occurrence of CRC, death, or censoring, tracked through 2018.
• The risk for CRC and use of colonoscopy under f-Hb-guided surveillance were compared with those under standard USMSTF‑recommended follow‑up care over a 9‑year period.

TAKEAWAY:

• During a mean follow-up period of 5.5 years, 1413 incident cases of CRC were identified, corresponding to an overall incidence rate of 2.8 per 1000 person-years (95% CI, 2.7-3.0).
• A clear gradient association was observed between baseline f-Hb levels and the risk for CRC after polypectomy , with adjusted hazard ratios (HRs) increasing stepwise to 1.72 (95% CI, 1.45-2.04) for f-Hb levels ≥ 450 μg Hb per gram of feces, using 20-49 μg Hb per gram of feces as the reference.
• Patients with a high-risk adenoma status had a higher risk for CRC (adjusted HR, 1.41; 95% CI, 1.27-1.58); however, the risk for CRC did not differ significantly by sex overall.
• The f-Hb-guided surveillance strategy was projected to reduce cumulative colonoscopy demand by 9.8% over 9 years, compared with standard USMSTF surveillance (160,316 vs 177,766 colonoscopies), while maintaining a comparable projected cumulative risk for CRC, with an overall projected risk reduction of 6.7%.

IN PRACTICE:

"These findings highlight the potential of f-Hb to improve risk stratification beyond endoscopic findings and support the integration of biological markers to guide precision surveillance," the authors of the study wrote.

SOURCE:

The study was led by Mark Pi-Chun Chuang, MD, National Taiwan University Hospital in Taipei, Taiwan. It was published online in Gastroenterology.

LIMITATIONS:

The study population consisted of individuals with conventional adenomas, limiting the generalizability of the findings to those with sessile serrated lesions or traditional serrated polyps. Data on high-grade dysplasia were incomplete during the study period and were not included in the analyses. Surveillance practices may not have strictly adhered to guideline recommendations. 

DISCLOSURES:

The study received support from the Health Promotion Administration, Ministry of Health and Welfare, and the National Science and Technology Council, Taiwan. The authors disclosed having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.