open access publication

Article, 2023

Faecal haemoglobin concentrations are associated with all-cause mortality and cause of death in colorectal cancer screening

BMC Medicine, ISSN 1741-7015, Volume 21, 1, Page 29, 10.1186/s12916-022-02724-3

Contributors

Kaalby, Lasse (Corresponding author) [1] [2] Deding, Ulrik 0000-0002-8263-2989 [1] [2] Al-Najami, Issam [1] Berg-Beckhoff, Gabriele 0000-0003-1614-938X [2] [3] Bjørsum-Meyer, Thomas 0000-0001-5253-0802 [1] [2] Laurberg, Tinne 0000-0002-7555-2665 [4] Shaukat, Aasma B [5] [6] Steele, Robert J C 0000-0003-4248-6785 [7] Koulaouzidis, Anastasios K 0000-0002-2248-489X [1] [2] Rasmussen, Morten Schnack 0000-0002-2560-1772 [8] Kobaek-Larsen, Morten 0000-0002-5097-9283 [1] [2] Baatrup, Gunnar 0000-0003-0300-5766 [1] [2]

Affiliations

  1. [1] Odense University Hospital
    2. [NORA names: Region of Southern Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  2. [2] University of Southern Denmark
    3. [NORA names: SDU University of Southern Denmark; University; Denmark; Europe, EU; Nordic; OECD];
  3. [3] Hospital South West Jutland
    4. [NORA names: Region of Southern Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  4. [4] Aarhus University Hospital
    5. [NORA names: Central Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD];
  5. [5] New York University
    6. [NORA names: United States; America, North; OECD];

Abstract

BackgroundColorectal cancer (CRC) screening reduces all-cause and CRC-related mortality. New research demonstrates that the faecal haemoglobin concentration (f-Hb) may indicate the presence of other serious diseases not related to CRC. We investigated the association between f-Hb, measured by a faecal immunochemical test (FIT), and both all-cause mortality and cause of death in a population-wide cohort of screening participants.MethodsBetween 2014 and 2018, 1,262,165 participants submitted a FIT for the Danish CRC screening programme. We followed these participants, using the Danish CRC Screening Database and several other national registers on health and population, until December 31, 2018. We stratified participants by f-Hb and compared them using a Cox proportional hazards regression on all-cause mortality and cause of death reported as adjusted hazard ratios (aHRs). We adjusted for several covariates, including comorbidity, socioeconomic factors, demography and prescription medication.ResultsWe observed 21,847 deaths in the study period. Our multivariate analyses indicated an association relationship between increasing f-Hb and the risk of dying in the study period. This risk increased steadily from aHR 1.38 (95% CI: 1.32, 1.44) in those with a f-Hb of 7.1–11.9 μg Hb/g faeces to 2.20 (95% CI: 2.10, 2.30) in those with a f-Hb ≥60.0 μg Hb/g faeces, when compared to those with a f-Hb ≤7.0 μg Hb/g faeces. The pattern remained when excluding CRC from the analysis. Similar patterns were observed between incrementally increasing f-Hb and the risk of dying from respiratory disease, cardiovascular disease and cancers other than CRC. Furthermore, we observed an increased risk of dying from CRC with increasing f-Hb.ConclusionsOur findings support the hypothesis that f-Hb may indicate an elevated risk of having chronic conditions if causes for the bleeding have not been identified. The mechanisms still need to be established, but f-Hb may be a potential biomarker for several non-CRC diseases.

Keywords

AhR, BackgroundColorectal cancer, CRC, CRC-related mortality, ConclusionsOur, ConclusionsOur findings, Cox, Cox proportional hazards regression, Danish CRC screening programme, ResultsWe, all-cause, all-cause mortality, analysis, associated with all-cause mortality, association, association relationship, biomarkers, bleeding, cancer, cancer screening, cardiovascular disease, cause of death, chronic conditions, colorectal cancer screening, comorbidity, concentration, conditions, covariates, database, death, demography, disease, elevated risk, f-Hb, factors, faeces, fecal hemoglobin concentration, fecal immunochemical test, findings, hazard, hazard ratio, hazards regression, health, hemoglobin concentration, hypothesis, immunochemical test, increased risk, mechanism, medication, mortality, multivariate analysis, national registers, participants, patterns, period, population, population-wide cohort, potential biomarkers, prescription, prescription medications, presence, programme, proportional hazards regression, ratio, register, regression, relationship, research, respiratory disease, risk, screening, screening database, screening programme, socioeconomic factors, stratified participants, study, study period, test

Funders

  • Danish Cancer Society
  • United States Department of Veterans Affairs

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