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 …

中文翻译：

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大肠癌个性化筛查，准备起飞

结直肠癌 (CRC) 是导致癌症相关死亡的最常见原因之一。1 为了进行基于人群的 CRC 筛查，粪便免疫化学检测 (FIT) 已被广泛接受。2 FIT 都可以定性使用，导致阳性或阴性结果，或导致报告每克粪便微克粪便血红蛋白 (Hb) 的定量方式。FIT 结果高于预设阈值的筛查对象将转诊进行结肠镜检查。较高的粪便 Hb 浓度与较高的晚期肿瘤风险相关。3 4 大多数筛查程序使用定量 FIT。然而，结果习惯性地以二分方式报告（即，低于或高于预先指定的阈值）。这种二分法随后错过了无数可能，其中确切的粪便 Hb 浓度可以指导临床决策。这些可能性之一是使用阴性 FIT 结果，换句话说，粪便 Hb 浓度低于可接受的临界值，作为后续筛选轮次中晚期肿瘤形成风险的预测指标。Senore 及其同事在 Gut 发表的漂亮论文为这一概念在探索粪便 Hb 的预测价值方面提供了额外的支持……