Balamou C, Koïvogui A, Rodrigue CM, Clerc A, Piccotti C, Deloraine A, Exbrayat C. Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program. World J Gastroenterol 2021; 27(31): 5272-5287 [PMID: 34497450 DOI: 10.3748/wjg.v27.i31.5272]
Corresponding Author of This Article
Christian Balamou, MD, MHSc, MSc, Doctor, Site de l'Ain, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, 58 rue Robespierre, Bourg-en-Bresse 01000, France. cbalamou@yahoo.fr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Aug 21, 2021; 27(31): 5272-5287 Published online Aug 21, 2021. doi: 10.3748/wjg.v27.i31.5272
Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program
Christian Balamou, Akoï Koïvogui, Christelle M Rodrigue, Aurélie Clerc, Claire Piccotti, Anne Deloraine, Catherine Exbrayat
Christian Balamou, Christelle M Rodrigue, Site de l'Ain, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Bourg-en-Bresse 01000, France
Akoï Koïvogui, Site de Seine-Saint-Denis, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France, Bondy 93146, France
Aurélie Clerc, Anne Deloraine, Sites Savoie & Haute Savoie, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Chambéry 73000, France
Claire Piccotti, Site de Drôme Ardèche, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Valence 26000, France
Catherine Exbrayat, Site Isère & Drôme-Ardèche, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Meylan 38240, France
Author contributions: The study was conceived and designed by Balamou C and Koïvogui A; the data was acquired and collated by Balamou C, Clerc A, Piccotti C, Deloraine A, and Exbrayat C; the data were analyzed by Balamou C, Koïvogui A, and Rodrigue CM; the study was drafted and revised critically by all authors; All authors gave final approval of the version to be published and have contributed to the study.
Institutional review board statement: This study is co-signed by the heads of the structures involved, as such, no further Institutional Review Board was required.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that was obtained after each patient agreed to participate in screening campaigns.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Data and materials are available when requested by e-mail. However, each request will be processed in accordance with French legislation on the availability of research data.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christian Balamou, MD, MHSc, MSc, Doctor, Site de l'Ain, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, 58 rue Robespierre, Bourg-en-Bresse 01000, France. cbalamou@yahoo.fr
Received: February 12, 2021 Peer-review started: February 12, 2021 First decision: April 18, 2021 Revised: May 3, 2021 Accepted: July 20, 2021 Article in press: July 20, 2021 Published online: August 21, 2021 Processing time: 186 Days and 14.8 Hours
ARTICLE HIGHLIGHTS
Research background
The rate of positive tests using fecal immunochemical test (FIT) does not decrease with subsequent campaigns, but the positive predictive value of advanced neoplasia significantly decreases in subsequent campaign after a first negative test. A relationship between the fecal hemoglobin concentration (Fhb) and the opportunity to detect a colorectal cancer in subsequent campaign has been shown.
Research motivation
In this period of implementation of the optimization strategies of the French program, our motivation was to alert the health authority on the severity of the lesions not diagnosed because of the high positivity threshold of the current screening FIT.
Research objectives
Our objective was to predict the severity of colorectal lesions based on Fhb measured during previous colorectal cancer screening campaign.
Research methods
The etiological study included 293750 patients aged 50-74, living in Auvergne-Rhône-Alpes (France). These patients completed at least two FIT [test(-1) and test(0)] between June 2015 and December 2019. Delay between test(-1) and test(0) was > 1 year, and test(-1) result was negative (< 150 ngHb/mL). The severity of colorectal lesions diagnosed at test(0) was described according to Fhb measured at test(-1) [Fhb(-1)]. The relationship between the severity classified in seven ordinal categories and the predictive factors was analyzed in an ordered multivariate polytomous regression model.
Research results
The test(0) positive rate was 4.0% and the colonoscopy completion rate was 97.1% in 11594 patients who showed a positive test(0). The colonoscopy detection rate was 77.7% in those 11254 patients who underwent a colonoscopy. In total, 8748 colorectal lesions were detected (including 2182 low-risk-polyps, 2400 high-risk-polyp and 502 colorectal cancer). The colonoscopy detection rate varied significantly with Fhb(-1) [0 ngHb/mL: 75.6%, (0-50): 77.3%, (50-100): 88.7%, (100-150): 90.3%; P = 0.001). People with a Fhb(-1) within (100-150 ngHb/mL) (P = 0.001) were 2.6 (2.2; 3.0) times more likely to have a high severity level compared to those having a Fhb(-1) value of zero. This severity risk was reduced by 20% in patients aged 55-59 compared to those aged < 55 [adjusted odds ratio: 0.8 (0.6; 1.0)].
Research conclusions
The study showed that higher Fhb(-1) is correlated to an increased risk of severity of colorectal lesions. This risk of severity increased among first-time participants (age < 55) and the elderly (≥ 70). To avoid the loss of chance in these age groups, the FIT positivity threshold should be reduced to 100 ngHb/mL. The other alternative would be to reduce the time between the two tests in these age groups from the current 2 years to 1 year.
Research perspectives
At the end of this study, we aim to conduct an experiment with a screening program considering the age of patients and the previous values of the fecal hemoglobin concentration.
