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Personalised screening for colorectal cancer, ready for take-off
  1. Ernst J Kuipers1,
  2. Esmée J Grobbee2
  1. 1 Erasmus MC University Medical Center, Rotterdam, The Netherlands
  2. 2 Department of Gastroenterology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  1. Correspondence to Professor Ernst J Kuipers, Erasmus University Medical Center, Rotterdam 3015 GD, The Netherlands; e.j.kuipers{at}erasmusmc.nl

http://dx.doi.org/10.1136/gutjnl-2019-319677

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    Colorectal cancer (CRC) is among the most common causes of cancer-related mortality.1 For the purpose of population-based CRC screening, faecal immunochemical tests (FIT) have been widely accepted.2 FIT can both be used in a qualitative manner, leading to either a positive or negative result, or a quantitative manner resulting in the reporting of microgram faecal haemoglobin (Hb) per gram faeces. Screenees with a FIT result above a prespecified threshold are referred for colonoscopy. A higher faecal Hb concentration is associated with a higher risk of advanced neoplasia.3 4 Most screening programmes use quantitative FIT. The results are however habitually reported in a dichotomised manner (ie, below or above a prespecified threshold). Such a dichotomised strategy subsequently misses out on countless possibilities in which the exact faecal Hb concentration could guide clinical decision-making. One of these possibilities is the use of negative FIT results, in other words faecal Hb concentrations below the accepted cut-off, as a predictor for the risk of advanced neoplasia in following screening rounds.

    The beautiful paper by Senore and colleagues in Gut provides additional support for this concept in exploring the predictive value of faecal Hb …

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    Footnotes

    • Contributors Both authors have together written the paper and approved the final version.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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