Faecal haemoglobin concentration predicts all-cause mortality

Ulrik Deding; Lasse Kaalby; Robert Steele; Issam Al-Najami; Morten Kobaek-Larsen; Eva Plantener; Jeppe B Madsen; Jonna S Madsen; Thomas Bjørsum-Meyer; Gunnar Baatrup

doi:10.1016/j.ejca.2023.02.009

Faecal haemoglobin concentration predicts all-cause mortality

Eur J Cancer. 2023 May:184:21-29. doi: 10.1016/j.ejca.2023.02.009. Epub 2023 Feb 15.

Authors

Affiliations

¹ Department of Surgery, Odense University Hospital, Svendborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark. Electronic address: ulrik.deding@rsyd.dk.
² Department of Surgery, Odense University Hospital, Svendborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
³ Centre for Research Into Cancer Prevention and Screening, University of Dundee School of Medicine, Dundee, UK.
⁴ Department of Surgery, Odense University Hospital, Svendborg, Denmark.
⁵ Department of Surgery, Odense University Hospital, Svendborg, Denmark; Department of Internal Medicine, Hospital of Southern Jutland, Aabenraa, Denmark.
⁶ Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
⁷ Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.

PMID: 36889038
DOI: 10.1016/j.ejca.2023.02.009

Abstract

Background: Population-based screening for colorectal cancer by a faecal immunochemical test (FIT) is recommended by the European Union. Detectable faecal haemoglobin can indicate colorectal neoplasia as well as other conditions. A positive FIT predicts an increased risk of death from colorectal cancer but might also predict an increased risk of all-cause mortality.

Methods: A cohort of screening participants was followed using the Danish National Register of Causes of Death. Data were retrieved from the Danish Colorectal Cancer Screening Database supplemented with FIT concentrations. Colorectal cancer specific and all-cause mortality were compared between FIT concentration groups using multivariate cox proportional hazards regression models.

Findings: In 444,910 Danes invited for the screening program, 25,234 (5·7%) died during a mean follow-up of 56·5 months. Colorectal cancer caused 1120 deaths. The risk of colorectal cancer death increased with the increasing FIT concentration. The hazard ratios ranged from 2·6 to 25·9 compared to individuals with FIT concentrations <4 μg hb/g faeces. Causes other than colorectal cancer caused 24,114 deaths. The risk of all-cause death increased with the increasing FIT concentration, with the hazard ratios ranging from 1·6 to 5·3 compared to individuals with FIT concentrations <4 μg hb/g faeces.

Interpretation: The risk of colorectal cancer mortality increased with the increasing FIT concentrations even for FIT concentrations considered negative in all European screening programs. The risk of all-cause mortality was also increased for individuals with detectable faecal blood. For colorectal cancer specific mortality and all-cause mortality, the risk was increased at the FIT concentrations as low as 4-9 μg hb/g faeces.

Funding: The study was funded by the Odense University Hospital grants A3610 and A2359.

Keywords: All-cause mortality; Colonoscopy; Colorectal cancer; Colorectal cancer mortality; FIT; Faecal immunochemical test; Screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Colonoscopy
Colorectal Neoplasms* / diagnosis
Early Detection of Cancer
Feces / chemistry
Hemoglobins / analysis
Humans
Mass Screening
Occult Blood
Proportional Hazards Models

Substances

Hemoglobins