Fecal Hemoglobin Levels in Prior Negative Screening and Detection of Colorectal Neoplasia: A Dose-Response Meta-Analysis
D Berg, Rosita van den Puttelaar, Lucie de Jonge, Iris Lansdorp‐Vogelaar, Esther Toes‐Zoutendijk
Abstract
BACKGROUND & AIMS: Prior studies have shown that individuals with fecal hemoglobin (f-Hb) concentrations just below the positivity cutoff have an increased colorectal cancer risk compared with those with no or low f-Hb. Understanding the dose-response association between f-Hb in a prior screening round and the detection of colorectal neoplasia is crucial for tailoring risk-based screening recommendations. METHODS: We searched the literature to identify studies reporting the association between f-Hb in prior screening round and colorectal neoplasia detection in an average-risk population. Analysis involved a 2-stage approach using log-log regression models to assess dose-response relationships across studies, with effect sizes pooled using a random effects model. Heterogeneity was assessed by excluding individual studies in sensitivity analyses. Subgroup analyses examined variations in effects by outcome definitions and detection methods. RESULTS: = 97.5%, P < .001) was observed, sensitivity analyses confirmed the consistency of findings. Subgroup analyses indicated that f-Hb concentrations from previous negative tests were especially predictive of advanced neoplasia in subsequent screenings. CONCLUSIONS: Our findings suggest that the risk of detecting colorectal neoplasia increases with prior f-Hb concentrations in negative tests, supporting the development of risk-stratified screening strategies based on these concentrations.