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• W2892390882 abstract "Background: Although cancer screening programs have been established in some Asian countries, resources are still insufficient to maintain high participation rates. The aim of this study was to assess whether any observed relationship persisted after adjusting for the pathologic stage of CRC to assess whether the increasing fecal hemoglobin (f-Hb) concentration on the risk of CRC death is partially explained by its intermediate influence on the pathologic stage of CRC and to propose the risk stratification by using f-Hb concentration for developing individual-tailored CRC screening. Methods: Over 1 million Taiwanese residents (n = 1,160,895) aged between 50 and 69 years participated in a biennial nationwide fecal immunochemical test (FIT) screening program between 2004 and 2009. The cohort was followed up over time to ascertain colorectal neoplasia and the causes of death until 2012. Cox regression model was operated to validate the definition of the surrogate end point such as tumor stage for the effect of f-Hb on CRC mortality and test the relationships between f-Hb in groups with increasing f-Hb and CRC mortality. The individual risk profiles based on f-Hb are proposed starting from average risk group to low risk and high risk group with biennial interscreening interval for risk prediction in advance colorectal cancer. Results: An incremental increase in both of baseline and updated f-Hb on the risk of advanced CRC cancer and CRC mortality were noted. A significant relationship was found between f-Hb and the risk for CRC mortality, increasing from a slightly increased risk for the category of f-Hb of 6 to 9 μg Hb/g (adjusted hazard ratio [HR] = 1.88; 95% CI, 1.41-2.50) to 33.04 (95% CI, 24.87-43.91) for the group with f-Hb ≥ 450 μg Hb/g as compared with the group with f-Hb of 1 to 5 ng Hb/mL (trend test, P < 0.001) at baseline after adjusting for age, gender. Taking 10-14 μg Hb/g (similar CRC mortality as general population) as standard, subjects with higher f-Hb at first screen should have a shorter interscreening interval with FIT. The screening interval could be altered to 1.5 year and 1 year for subjects with f-Hb of 15-19 μg Hb/g and f-Hb of 20-49 μg Hb/g, respectively. On the other hand, the interval between repeated FIT screens could be extended to avoid false positive cases for those with a lower f-Hb. The screening interval could be lengthened as 3 year for subjects with f-Hb of 6-9 μg Hb/g. Conclusion: We confirmed the direct relationship between f-Hb and colorectal cancer mortality, which is explained by the role of f-Hb as a surrogate for advanced CRC. Different interscreenings by different f-Hb concentrations are recommended. Individualized interscreening intervals by different f-Hb level or together with other factors could be further considered for personalized CRC screening." @default.
• W2892390882 created "2018-10-05" @default.
• W2892390882 creator A5010330477 @default.
• W2892390882 date "2018-10-01" @default.
• W2892390882 modified "2023-09-25" @default.
• W2892390882 title "Fecal Hemoglobin Concentrations and Personalized Screening for Colorectal Cancer" @default.
• W2892390882 doi "https://doi.org/10.1200/jgo.18.85600" @default.
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