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Showing content from https://pubmed.ncbi.nlm.nih.gov/28376228/ below:

Association Between Colorectal Cancer Mortality and Gradient Fecal Hemoglobin Concentration in Colonoscopy Noncompliers

. 2017 May 1;109(5):djw269. doi: 10.1093/jnci/djw269. Association Between Colorectal Cancer Mortality and Gradient Fecal Hemoglobin Concentration in Colonoscopy Noncompliers Sam Li-Sheng Chen³, Amy Ming-Fang Yen³, Sherry Yueh-Hsia Chiu⁴, Jean Ching-Yuan Fann⁵, Shu-Lin Chuang², Tsung-Hsien Chiang^{1 6 7}, Chu-Kuang Chou^{1 8}, Han-Mo Chiu^{1 2}, Ming-Shiang Wu¹, Chien-Yuan Wu⁹, Shu-Li Chia⁹, Shu-Ti Chiou^{9 10}, Hsiu-Hsi Chen²

Affiliations

¹ Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
² College of Medicine, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
³ School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan.
⁵ Department of Health Industry Management, Kainan University, Tao-Yuan, Taiwan
⁶ Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.
⁷ Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
⁸ Division of Gastroenterology and Hepatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
⁹ Health Promotion Administration, Ministry of Health and Welfare, Taiwan.
¹⁰ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.

PMID: 28376228
PMCID: PMC5441293
DOI: 10.1093/jnci/djw269

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Association Between Colorectal Cancer Mortality and Gradient Fecal Hemoglobin Concentration in Colonoscopy Noncompliers

Yi-Chia Lee et al. J Natl Cancer Inst. 2017.

. 2017 May 1;109(5):djw269. doi: 10.1093/jnci/djw269. Authors Yi-Chia Lee^{1 2}, Sam Li-Sheng Chen³, Amy Ming-Fang Yen³, Sherry Yueh-Hsia Chiu⁴, Jean Ching-Yuan Fann⁵, Shu-Lin Chuang², Tsung-Hsien Chiang^{1 6 7}, Chu-Kuang Chou^{1 8}, Han-Mo Chiu^{1 2}, Ming-Shiang Wu¹, Chien-Yuan Wu⁹, Shu-Li Chia⁹, Shu-Ti Chiou^{9 10}, Hsiu-Hsi Chen² Affiliations

¹ Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
² College of Medicine, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
³ School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Department and Graduate Institute of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan.
⁵ Department of Health Industry Management, Kainan University, Tao-Yuan, Taiwan
⁶ Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.
⁷ Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
⁸ Division of Gastroenterology and Hepatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
⁹ Health Promotion Administration, Ministry of Health and Welfare, Taiwan.
¹⁰ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.

PMID: 28376228
PMCID: PMC5441293
DOI: 10.1093/jnci/djw269

Item in Clipboard

Abstract

Background: To what extent the risk for colorectal cancer (CRC) death among noncompliers of colonoscopy is elevated following positive fecal immunological testing and whether the elevated risk varies with the fecal hemoglobin concentration (f-Hb) and location of CRC have not been researched.

Methods: We used data on 59 389 individuals (4.0%) among 1 489 937 Taiwanese screenees age 50 to 69 years with f-Hb 20 μg hemoglobin or more per gram of feces from 2004 to 2009. They were classified into 41 995 who received colonoscopy and 10 778 who received no confirmatory examination; the latter was categorized into three risk groups according to f-Hb (20-49, 50-99, and 100+). Mortality from CRC as the primary end point was monitored until December 31, 2012.

Results: A 1.64-fold (95% confidence interval [CI] = 1.32 to 2.04) increased risk for CRC death for the noncolonoscopy group as opposed to the colonoscopy group adjusting for differences in baseline characteristics. A gradient relationship was noted between cumulative mortality and age- and sex-adjusted f-Hb categories with 1.31-fold (95% CI = 1.04 to 1.71), 2.21-fold (95% CI = 1.55 to 3.34), and 2.53-fold (95% CI = 1.95 to 3.43) increased risk, respectively, for the 20-49, 50-99, and 100+ risk groups in the noncolonoscopy group compared with the colonoscopy group. The noncolonoscopy group led to a statistically significant 1.75-fold increased risk (95% CI = 1.35 to 2.33) for CRC of the distal colon but a statistically nonsignificant 1.11-fold increased risk (95% CI = 0.70 to 1.75) for the proximal colon, compared with the colonoscopy group. When the comparator was limited to subjects whose colonoscopy was completed to the cecum, the statistically significantly elevated risk for CRC mortality was seen for both distal and proximal colon in the noncolonoscopy group.

Conclusions: After a positive fecal immunochemical test, colonoscopy can reduce by about half the number of deaths from CRC. Among colonoscopy noncompliers, higher f-Hb is associated with an increased risk of mortality from CRC in a dose-response manner.

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Figures
Figure 1.

Cumulative incidence of colorectal cancer…

Figure 1.

Cumulative incidence of colorectal cancer according to study group (referral n = 41…

Figure 1.

Cumulative incidence of colorectal cancer according to study group (referral n = 41 995 vs nonreferral n = 10 778). The difference between the two groups was assessed by using the Poisson method, two-sided. CI = confidence interval; RR = relative risk.

Figure 2.

Cumulative incidence of colorectal cancer…

Figure 2.

Cumulative incidence of colorectal cancer according to study group (referral vs nonreferral) and…

Figure 2.

Cumulative incidence of colorectal cancer according to study group (referral vs nonreferral) and cancer stage.

Figure 3.

Cumulative mortality and survival of…

Figure 3.

Cumulative mortality and survival of colorectal cancer according to study group. A) Cumulative…

Figure 3.

Cumulative mortality and survival of colorectal cancer according to study group. A) Cumulative mortality rates of colorectal cancer (CRC) according to the study group (referral vs nonreferral), adjusting for city/county clustering, age, sex, screening round, fecal hemoglobin concentration, and propensity score. B) Cumulative survival probability of patients with CRC according to the study group (referral vs nonreferral), adjusted for lead time in the referral group. aRR = adjusted relative risk; CI = confidence interval; HR = hazard ratio.

Figure 4.

Cumulative mortality rates of the…

Figure 4.

Cumulative mortality rates of the nonreferral group, stratified by risk score. Based on…

Figure 4.

Cumulative mortality rates of the nonreferral group, stratified by risk score. Based on age- and sex-adjusted f-Hb, the noncolonoscopy group was categorized into three risk groups of f-Hb 20-49 (n = 5361), f-Hb 50-99 (n = 2149), and f-Hb 100 + (n = 3268). The data was analyzed using the Cox proportional hazards regression model.

Figure 5.

Concentrations of f-Hb and standard…

Figure 5.

Concentrations of f-Hb and standard deviation stratified by the stages of colorectal cancer…

Figure 5.

Concentrations of f-Hb and standard deviation stratified by the stages of colorectal cancer (CRC). In referrals, the f-Hb denotes the quantitative measure at the time of screening for screen-detected colorectal cancer. In nonreferrals, the f-Hb indicates the quantitative measure at the time of screening associated with the staging of CRC when subjects did not comply with initial colonoscopy and their CRCs eventually developed clinical symptoms to raise medical attention. The error bars represent the standard deviation of the f-Hb concentration.