Improved use of faecal immunochemical tests for haemoglobin in the Scottish bowel screening programme - Abstract and study results

Sep 24, 2026

Uploaded by Aran

Objectives: develop a risk-scoring model in the Scottish Bowel Screening Programme (SBSP) incorporating faecal haemoglobin concentration with other colorectal cancer risk factors. Methods: data were collected from all SBSP invitees between November 2017 and March 2018, linking screening records to the Scottish Cancer Registry and using logistic regression to assess associations. Results: among 232,076 participants, age and faecal haemoglobin were significant; interval cancer proportions increased with age. Conclusions: a usable risk model was not feasible; adjusting faecal haemoglobin thresholds by age may reduce sex disparities and warrants further study.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Abstract

Objectives

Methods

Results

Conclusions

Background

FIT vs gFOBT in bowel screening

Threshold selection and sensitivity

Improved use of faecal immunochemical tests for haemoglobin in the Scottish bowel screening programme Jayne Digby 1 , Callum G Fraser 1 , Gavin Clark2 , Craig Mowat3, Judith A Strachan4 and Robert JC Steele 1 J Med Screen 2023, Vol. 30(4) 184–190 © The Author(s) 2023 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/09691413231175611](DOI: 10.1177/09691413231175611)[ ](DOI: 10.1177/09691413231175611)[journals.sagepub.com/home/msc](journals.sagepub.com/home/msc) Abstract Objectives: This study aimed to develop a risk-scoring model in the Scottish Bowel Screening Programme incorporating faecal haemoglobin concentration with other risk factors for colorectal cancer. Methods: Data were collected for all individuals invited to participate in the Scottish Bowel Screening Programme between November 2017 and March 2018 including faecal haemoglobin concentration, age, sex, National Health Service Board, socioeconomic status, and screening history. Linkage with The Scottish Cancer Registry identiﬁed all screening participants diagnosed with colorectal cancer. Logistic regression was performed to identify which factors demonstrated signiﬁcant association with colorectal cancer and could be used in the development of a risk-scoring model. Results: Of 232,076 screening participants, 427 had colorectal cancer: 286 diagnosed following a screening colonoscopy and 141 arising after a negative screening test result giving an interval cancer proportion of 33.0%. Only faecal haemoglobin concentration and age showed a statistically signiﬁcant association with colorectal cancer. Interval cancer proportion increased with age and was higher in women (38.1%) than men (27.5%). If positivity in women were mirrored in men at each age quintile interval cancer proportion would still have remained higher in women (33.2%). Moreover, an additional 1201 colonoscopies would be required to detect 11 colorectal cancers. Conclusions: Development of a risk scoring model using early data from the Scottish Bowel Screening Programme was not feasible due to most variables showing insigniﬁcant association with colorectal cancer. Tailoring the faecal haemoglobin concentration threshold according to age could help to diminish some of the disparity in interval cancer proportion between women and men. Strategies to achieve sex equality using faecal haemoglobin concentration thresholds depend considerably on which variable is selected for equivalency and this requires further exploration. Keywords Colorectal cancer screening, faecal immunochemical test, faecal haemoglobin, sex differences Date received: 8 March 2023; accepted: 26 April 2023 Background Screening for colorectal cancer (CRC) using tests for the presence of haemoglobin in faeces as the initial test, followed by colonoscopy for a positive test result, has been proven to reduce disease-speciﬁc mortality in population-based randomised controlled trials 1 and many countries world-wide have instigated screening programmes based on this evidence. The initial studies of CRC screening were conducted using guaiacbased faecal occult blood tests (gFOBT), but these have been superseded by faecal immunochemical tests (FIT) for haemoglobin since, unlike gFOBT, these are speciﬁc for human haemoglobin, detect only colorectal bleeding, testing can be automated eliminating human error, and they can provide a quantitative estimate of faecal haemoglobin concentration (f-Hb) . In addition, in a population screening context, they are associated with higher uptake than gFOBT owing to a simpliﬁed testing algorithm involving only one sample, a more user-friendly hygienic collection device and a perception that they are modern, scientiﬁc and more reliable.2 As a result, 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Dundee, Scotland, UK 2Public Health Scotland, Edinbur

FAQs

What was the primary objective of the study?

To develop a risk-scoring model for colorectal cancer in the Scottish Bowel Screening Programme that combines faecal haemoglobin concentration with other risk factors.

Which factors showed a statistically significant association with colorectal cancer?

Only faecal haemoglobin concentration and age demonstrated statistically significant association; other variables were not significant.

Why might adjusting the faecal haemoglobin threshold by age be important?

The study indicates interval cancer proportions differ by sex and increase with age; tailoring the threshold by age could help reduce some of this disparity, though strategies require further exploration.

Sep 24, 2026

Uploaded by Aran