Advanced neoplasia risk found to increase at upper range of negative FIT values

Individuals in the upper range of fecal immunochemical test (FIT)-negative screening have an increased risk for advanced neoplasia (AN), according to a research letter published online Nov. 7 in the Annals of Internal Medicine.

Tobias Niedermaier, Ph.D., from the German Cancer Research Center in Heidelberg, and colleagues provided a dose-response analysis of the association between fecal hemoglobin concentrations and the presence of AN (colorectal cancer or advanced adenoma) in an ongoing study involving participants of screening colonoscopy in Germany. A quantitative FIT was performed before screening colonoscopy. Data were included for 7,398 participants; 90.0 percent had fecal hemoglobin concentrations below the recommended FIT cutoff (17 µg/g).

The researchers found that 41 and 81 percent of all participants had hemoglobin concentrations <1.7 and <8 µg/g feces, respectively. There was an increase observed in the prevalence of AN, from 6 percent among those with hemoglobin concentrations <1.7 µg/g to 22 percent in the highest group of participants with FIT-negative results and up to 51 percent for those with FIT-positive results. Positivity was 9.9 percent at a FIT cutoff of 17 µg/g; sensitivity and positive predictive value for AN detection were 39 percent, while specificity and negative predictive value were 93 percent.

"Those in the upper range of negative FIT values are at higher risk for colorectal cancer than those in the lower range," the authors write. "Despite increased complexity, this suggests a benefit from personalized screening intervals."

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