Hemoglobin stool screening is not only useful for the prevention of colorectal carcinomas

A large Danish prospective cohort study found that increasing levels of fecal hemoglobin (f-Hb) are associated with an increase of 30 %–250 % of deaths from non-colorectal cancer (CRC), respiratory disease and cardiovascular disease (CVD).

Why this matters

The results of one of the largest studies of their kind suggest that f-Hb screening could be useful beyond CRC prevention.

Study design

Prospective cohort study with 1,262,165 Participants of the Danish CRC screening program from 2014 to 2018.
Exposure yielded f-Hb levels with a low value of 7.0 or less μg Hb/g Stool above slightly elevated values (7.1–11.9 μg Hb/g stool) up to high values of 60.0 or more μg Hb/g Chair.
Primary endpoints: All-cause mortality and non-CRC-related causes of death after adjustment for sociodemographic factors, gastrointestinal bleeding-causing diseases, and other prescription drugs, and comorbidity.
Funding: The Danish Cancer Society; U.S. Department of Veterans Affairs; other.

Key results

The median follow-up time was 2.68 Years.
CRC mortality was increased with increasing f-Hb (from aHR: 1.84; 95 %-CI: 1.354–2.50 at slightly elevated values to aHR: 16.22; 95 %-CI: 13.51–19.49 at high values).
For these non-CRC-related results, a pattern of mortality increase of 30 %–250 % with increasing f-Hb (each value vs.low value of 7,0 μg or less Hb/g stool) observed:
- All-cause mortality (from aHR: 1.38; 95 %-CI: 1.32–1.44 at slightly elevated values, to aHR: 2.20; 95 %-CI: 2.10–2.30 at high values).
- All-cause mortality without CRC (from aHR: 1.37; 95 %-CI: 1.31–1.43 at slightly elevated values to aHR: 1.98; 95 %-CI: 1.89–2.08 at high values).
- Respiratory mortality (from aHR: 1.38; 95 %-CI: 1.26–1.51 at slightly elevated values to aHR: 2.35; 95 % CI: 2.16–2.57 at high values).
- CVD mortality (from aHR: 1.34; 95 %-CI: 1.22–1.47 at slightly elevated values to aHR: 2.09; 95 %-CI: 1.90–2.29 at high values).
- Mortality from cancer other than CRC (from aHR: 1.33; 95 %-CI: 1.24–1.42 at slightly elevated values to aHR: 1.77; 95 % CI: 1.64–1.91 at high values).
- Diabetes mortality (from non-significant aHR at slightly elevated values to aHR: 1.64; 95 %-CI: 1.20–2.24 at high levels).

All-cause mortality (from aHR: 1.38; 95 %-CI: 1.32–1.44 at slightly elevated values, to aHR: 2.20; 95 %-CI: 2.10–2.30 at high values).
All-cause mortality without CRC (from aHR: 1.37; 95 %-CI: 1.31–1.43 at slightly elevated values to aHR: 1.98; 95 %-CI: 1.89–2.08 at high values).
Respiratory mortality (from aHR: 1.38; 95 %-CI: 1.26–1.51 at slightly elevated values to aHR: 2.35; 95 % CI: 2.16–2.57 at high values).
CVD mortality (from aHR: 1.34; 95 %-CI: 1.22–1.47 at slightly elevated values to aHR: 2.09; 95 %-CI: 1.90–2.29 at high values).
Mortality from cancer other than CRC (from aHR: 1.33; 95 %-CI: 1.24–1.42 at slightly elevated values to aHR: 1.77; 95 % CI: 1.64–1.91 at high values).
Diabetes mortality (from non-significant aHR at slightly elevated values to aHR: 1.64; 95 %-CI: 1.20–2.24 at high levels).

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