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Licensed Unlicensed Requires Authentication Published by De Gruyter April 22, 2020

Faecal haemoglobin distributions by sex, age, deprivation and geographical region: consequences for colorectal cancer screening strategies

  • Gavin R.C. Clark , Judith A. Strachan , Alisson McPherson , Jayne Digby , Craig Mowat , Robert J.C. Steele and Callum G. Fraser ORCID logo EMAIL logo

Abstract

Objectives

Faecal immunochemical tests for haemoglobin (FIT) are becoming widely used in colorectal cancer (CRC) screening and assessment of symptomatic patients. Faecal haemoglobin concentration (f-Hb) thresholds are used to guide subsequent investigation. We established the distributions of f-Hb in a large screening population by sex, age, deprivation and geography.

Methods

Single estimates of f-Hb were documented for all individuals participating in the first 18 months of the Scottish Bowel Screening Programme (SBoSP). The distributions of f-Hb were generated for all participants, all men and women, and men and women by age quintile and deprivation quintile. Distributions were also generated by geographical region for all participants, men and women, and by deprivation. Comparisons of f-Hb distributions with those found in a pilot evaluation of FIT and three other countries were performed.

Results

f-Hb was documented for 887,248 screening participants, 422,385 men and 464,863 women. f-Hb varied by sex, age, deprivation quintile and geographical region. The f-Hb distributions by sex and age differed between the SBoSP and the pilot evaluation and the three other countries.

Conclusions

f-Hb is higher in men than in women and increases with age and deprivation in both sexes. f-Hb also varies by geographical region, independently of deprivation, and by country. The f-Hb distribution estimated by pilot evaluation may not represent the population distribution. Decision limits have advantages over reference intervals. Use of partitioned f-Hb thresholds for further investigation, based on the data generated, has advantages and disadvantages, as do risk scores based on a spectrum of influencing variables.


Corresponding author: Prof. Callum G. Fraser, Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK, Phone: +44 (0)1382 553799, E-mail:

  1. Author contributions: CGF, GRCC and RJCS conceived and planned the study. GRCC generated the data and calculated the f-Hb distribution centiles. JAS is Director of the Scottish Bowel Screening Laboratory, responsible for oversight of the generation of all f-Hb results. AMcP is responsible for the day-to-day running of the SBoSL and the generation of the f-Hb results. JD is research fellow funded by Bowel Cancer UK, the funder of this study. CM is consultant gastroenterologist and provided expertise in the potential clinical applications of the results. RJCS is Director of the SBoSP. All authors contributed to the data analysis. All authors provided significant input to interpretation of the data and to the writing of the paper. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  2. Research funding: JD is supported by a grant from Bowel Cancer UK (Funder Id: http://dx.doi.org/10.13039/100013791, https://www.bowelcanceruk.org.uk/research/our-research/current-research-projects/improving-use-of-the-faecal-immunochemical-test/).

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: CGF has undertaken paid consultancy with Hitachi Chemical Diagnostics Systems, Co., Ltd, Tokyo, Japan. Other authors have no interests to declare. Research funding played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  6. Informed consent: Informed consent was not required from individuals included in this study.

  7. Ethical approval: Neither ethical approval nor individual informed consent were required since this study used only data that were integral components of the Scottish Bowel Screening Programme.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-0268).


Received: 2020-03-06
Accepted: 2020-04-02
Published Online: 2020-04-22
Published in Print: 2020-11-26

©2020 Walter de Gruyter GmbH, Berlin/Boston

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