Fecal hemoglobin concentration as a measure of risk to tailor colorectal cancer screening: are we there yet?

Eur J Cancer Prev. 2015 Jul;24(4):321-7. doi: 10.1097/CEJ.0000000000000090.


The aim of this paper was to examine the distribution of fecal hemoglobin (f-Hb) concentration in a Spanish colorectal cancer screening population according to sociodemographic characteristics and analyze whether f-Hb was associated with clinical outcomes (type of lesion and its location). From September 2009 to November 2012, we sent 77,744 invitations to individuals aged 50-69 years to provide one sample of feces. f-Hb was measured on samples from 27,606 screenees (35.5%). Colonoscopy findings and pathology data were collected on the 1406 screenees with f-Hb greater than 100 ng Hb/ml (20 mg Hb/g feces). The Mann-Whitney U-test and the Kruskal-Wallis test were used to compare f-Hb (median) according to sociodemographic variables, clinical outcomes, and histological features of adenomas. f-Hb from greater than 100 ng Hb/ml was categorized into quartiles. Regression models were used to determine whether f-Hb was a risk predictor of colorectal lesions. f-Hb was associated directly with the severity of the colorectal lesions. An overlap between individuals with a negative colonoscopy and those with a low-risk adenoma was observed. High-grade dysplasia, villous histology, distal location, and increasing size were all features associated with an increased f-Hb level. f-Hb could be used in individual risk assessment to determine surveillance strategies for colorectal cancer screening.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / diagnosis*
  • Adenoma / pathology
  • Aged
  • Carcinoma / diagnosis*
  • Carcinoma / pathology
  • Cohort Studies
  • Colon / pathology
  • Colonoscopy
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / pathology
  • Early Detection of Cancer / methods*
  • Feces / chemistry*
  • Female
  • Hemoglobins / analysis*
  • Humans
  • Immunochemistry
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Occult Blood*
  • Rectum / pathology


  • Hemoglobins