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Abstract
Objective An association between detectable faecal haemoglobin (f-Hb) and both the risk of death from colorectal cancer (CRC) and all-cause mortality has been reported. We set out to confirm or refute this observation in a UK population and to explore the association between f-Hb, as indicated by a positive guaiac faecal occult blood test (gFOBT) result, and different causes of death.
Design All individuals (134 192) who participated in gFOBT screening in Tayside, Scotland between 29/03/2000 and 29/03/2016 were studied by linking their test result (positive or negative) with mortality data from the National Records of Scotland database and following to 30/03/2016.
Results Those with a positive test result (n=2714) had a higher risk of dying than those with a negative result, from CRC: HR 7.79 (95% CI 6.13 to 9.89), p<0.0001, (adjusted for, gender, age, deprivation quintile and medication that can cause bleeding) and all non-CRC causes: HR 1.58 (95% CI 1.45 to 1.73), p<0·0001.· In addition, f-Hb detectable by gFOBT was significantly associated with increased risk of dying from circulatory disease, respiratory disease, digestive diseases (excluding CRC), neuropsychological disease, blood and endocrine disease and non-CRC.
Conclusion The presence of detectable f-Hb is associated with increased risk of death from a wide range of causes.
- bleeding
- colorectal cancer
- screening
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Footnotes
Contributors GL performed the statistical analyses and contributed to the writing of the manuscript. CGF directed the FOBT analyses, participated in analysis of results and contributed to the writing of the manuscript. FAC directed the pathological and histological examination of lesions found at colonoscopy, participated in analysis of results and contributed to the writing of the manuscript. DHB provided data on causes of death, participated in analysis of results and contributed to the writing of the manuscript. RJCS conceived the study, prepared the first draft of the manuscript and is the guarantor for the study.
Funding Funded by the Chief Scientist Office of the Scottish Government Health Department. Project: Establishing a Bowel Screening Research Unit (Grant Ref: CZH/6/4).
Disclaimer The funder had no role in the study design, data collection, statistical analyses, interpretation of the results or writing of the manuscript.
Competing interests CGF undertook consultancy with Immunostics Inc., Ocean, New Jersey, USA. All other authors declare no competing interests.
Patient consent Not required.
Ethics approval The study received Caldicott approval. It did not require an ethics application since the data were obtained through the Health Informatics Centre, University of Dundee, which has generic ethics approval for linkage projects.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data sharing should be discussed with Professor RJCS, corresponding author.