Faecal haemoglobin concentrations in women and men diagnosed with colorectal cancer in a national screening programme

Abstract

Objective There is evidence that colorectal cancer screening using faecal haemoglobin is less effective in women than men. The faecal haemoglobin concentrations were therefore examined in women and men with screen-detected colorectal cancer. Setting Scottish Bowel Screening Programme, following the introduction of a faecal immunochemical test from November 2017, to March 2020. Methods Data were collated on faecal haemoglobin concentrations, pathological stage and anatomical site of the main lesion in participants who had colorectal cancer detected. The data in women and men were compared. Results For the faecal haemoglobin concentrations studied (>80 µg Hb/g faeces), the distributions indicated lower concentrations in women. Marked differences were found between women and men diagnosed with colorectal cancer. The median faecal haemoglobin concentration for women ( n = 720) was 408 µg Hb/g faeces compared to 473 µg Hb/g faeces for men ( n = 959) ( p = 0.004) and 50.6% of the results were >400 µg Hb/g faeces in women; in men, this was 57.8%. The difference in faecal haemoglobin concentrations in women and men became less statistically significant as stage advanced from stages I–IV. For right-sided, left-sided and rectal colorectal cancer, a similar gender difference persisted in all sites. Differences in faecal haemoglobin between the genders were significant for left-sided cancers and stage I and approached significance for rectal cancers and stage II, but all sites and stages showed lower median faecal haemoglobin concentrations for women. Conclusions To minimise gender inequalities, faecal immunochemical test-based colorectal cancer screening programmes should evaluate a strategy of using different faecal haemoglobin concentration thresholds in women and men.

Interval cancers in a population-based screening program for colorectal cancer with gender-specific cut-off levels for fecal immunochemical test

“…The evaluation was imperative as FIT-based screening is being implemented nationally in Sweden and gender-based screening is being rolled out or called for in other European countries. 9,16 The IC incidence rate in the present study was 46 per 100 000 person-years. This is much higher than that of a recent meta-analysis by Wieten et al but most of the included studies were in younger populations, applied a cut-off 20 µg/ g or lower, and involved multiple screening rounds.…”

“…The evaluation was imperative as FIT-based screening is being implemented nationally in Sweden and gender-based screening is being rolled out or called for in other European countries. 9 , 16 …”

Sex variation in colorectal cancer mortality: trends and implications for screening

“…In addition, irrespective of tumour stage and anatomical location, women with FIT screen-detected CRC have lower f-Hb concentrations than men. 9 …”

“…We have recently found that screen-detected CRC in women is associated with lower f-Hb concentrations than men. 9 This indicates that screening using f-Hb has lower sensitivity for CRC in women than in men and it might be expected that the effect of screening on CRC mortality would be less in women than in men; indeed, the results of long-term follow-up of the Minnesota trial of gFOBT screening support this conclusion. 10 Further confirmation comes from a recent study, showing that, in a retrospective cohort study on the FIT-based screening programme in the Italian region of Emilia-Romagna during the period 2005–16, following 707 751 individuals, CRC mortality was reduced by 54% and 75%, respectively, in women and men who participated regularly.…”

Interval cancer after two rounds of a Swedish population-based screening program using gender-specific cut-off levels in fecal immunochemical test

“…However, the Scottish study was only conducted in screening-detected CRCs with FIT ≥80 µg/g. 14 Gender-specific FIT screening has been proposed to achieve equal positivity in men and women but is currently only used in Finland and Sweden. [15][16][17] We recently reported the first screening round in the Swedish population-based program of Stockholm-Gotland applying cut-off levels of 40 µg/g in women and 80 µg/g in men, and demonstrated a higher test sensitivity in women than in men and a tendency towards a higher IC rate in men when compared to the background CRC incidence.…”