Cause of Death, Mortality and Occult Blood in Colorectal Cancer Screening
by
, , , ,
Lasse Kaalby
1,2,*
,
Issam Al-Najami
1,
Ulrik Deding
1,2,
Gabriele Berg-Beckhoff
3,4,
Robert J. C. Steele
5,
Morten Kobaek-Larsen
1,2,
Aasma Shaukat
6,7,
Morten Rasmussen
8 and
Gunnar Baatrup
1,2 1
Department of Surgery, Odense University Hospital, 5000 Odense, Denmark
2
Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
3
Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, 6700 Esbjerg, Denmark
4
Unit for Health Research, Hospital South West Jutland, 6700 Esbjerg, Denmark
5
Centre for Research into Cancer Prevention and Screening, University of Dundee School of Medicine, Dundee DD1 9SY, UK
6
GI Section, Minneapolis VA Medical Center and University of Minnesota, Minneapolis, MN 55417, USA
7
Division of Gastroenterology NYU Langone, New York, NY 10016, USA
8
Digestive Disease Center, Bispebjerg University Hospital, 2400 Copenhagen, Denmark
*
Author to whom correspondence should be addressed.
Cancers 2022, 14(1), 246; https://doi.org/10.3390/cancers14010246
Submission received: 22 December 2021
/
Revised: 27 December 2021
/
Accepted: 29 December 2021
/
Published: 4 January 2022
Simple Summary
Colorectal cancer (CRC) screening participants with significant traces of hemoglobin in their stool have been reported to have higher mortality and different causes of death (other than CRC) compared to those without. We aimed to investigate these differences among screening participants after 33 years of follow-up. We confirmed that participants with detectable fecal hemoglobin were more likely to die in the study period and to die from different causes, such as cardiovascular and endocrine and hematological diseases, compared to those without detectable fecal hemoglobin. This confirms that fecal hemoglobin may have potential as a marker for diseases not directly related to the colon and rectum and may represent a target for future preventive measures.
Abstract
Fecal hemoglobin (f-Hb) detected by the guaiac fecal occult blood test (gFOBT) may be associated with mortality and cause of death in colorectal cancer (CRC) screening participants. We investigated this association in a randomly selected population of 20,694 participants followed for 33 years. We followed participants from the start of the Hemoccult-II CRC trial in 1985–1986 until December 2018. Data on mortality, cause of death and covariates were retrieved using Danish national registers. We conducted multivariable Cox regressions with time-varying exposure, reporting results as crude and adjusted hazard ratios (aHRs). We identified 1766 patients with at least one positive gFOBT, 946 of whom died in the study period. Most gFOBT-positive participants (93.23%) died of diseases unrelated to CRC and showed higher non-CRC mortality than gFOBT-negative participants (aHR: 1.20, 95% CI 1.10–1.30). Positive gFOBT participants displayed a modest increase in all-cause (aHR: 1.28, 95% CI: 1.18–1.38), CRC (aHR: 4.07, 95% CI: 3.00–5.56), cardiovascular (aHR: 1.22, 95% CI: 1.07–1.39) and endocrine and hematological mortality (aHR: 1.58, 95% CI: 1.19–2.10). In conclusion, we observed an association between positive gFOBT, cause of death and mortality. The presence of f-Hb in the gFOBT might indicate the presence of systemic diseases.
Keywords:
colorectal cancer; screening; fecal hemoglobin; cause of death; mortality
