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Vol. 62 No. 3 (2026)
DOI: 10.4415/ANN_26_03_10
Original Articles
2026-07-09
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Three-year risk of colorectal cancer by faecal haemoglobin concentration in subjects with a negative FIT

Authors

Donella Puliti , Giuseppe Gorini , Adele Caldarella , Teresa Intrieri , Zhanna Tumanova , Gianfranco Manneschi , Carmen Beatriz Visioli , Beatrice Mallardi , Francesca Battisti , Simonetta Bisanzi , Cristina Sani , Giovanna Masala , Marco Zappa , Paola Mantellini

Abstract

Introduction and aim. To evaluate whether a risk-stratified colorectal cancer (CRC) screening approach based on a single faecal immunochemical test (FIT) performed better than one using two consecutive tests.
Methods. Approximately 420,000 negative FIT results (positivity cut-off: 20 μg faecal haemoglobin, f-Hb/g) were collected between 2000 and 2015 within the Florence screening program.
Results. The 3-year CRC risk was 15.9‰ in individuals with 15-20 μg/g on a single test, and 9.36‰ for those with a cumulative f-Hb concentration of 20-40 μg/g across two tests.
Discussion. The two-tests approach showed lower discriminatory capacity in identifying the highest-risk subgroup compared to a single test. Screenees with 15-20 μg/g accounted for <1%, but faced a significantly increased 3-year CRC risk.
Conclusion. While increasing screening intensity would require more colonoscopies, extending the screening interval for individuals <60 years with undetectable f-Hb, could allow for the reallocation of colonoscopy resources.

Keywords: colorectal cancer, faecal haemoglobin concentration, faecal immunochemical test (FIT)

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Authors

Donella Puliti - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

Giuseppe Gorini - ISPRO

Adele Caldarella - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

Teresa Intrieri - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

Zhanna Tumanova - Dipartimento di Sanità Pubblica, Università degli Studi di Firenze, Florence, Italy

Gianfranco Manneschi - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

Carmen Beatriz Visioli - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

Beatrice Mallardi - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

Francesca Battisti - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

Simonetta Bisanzi - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

Cristina Sani - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

Giovanna Masala

Marco Zappa - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

Paola Mantellini - Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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Copyright (c) 2026 Istituto Superiore di Sanità

How to Cite
Puliti, D., Gorini, G., Caldarella, A., Intrieri, T., Tumanova, Z., Manneschi, G., Visioli, C. B., Mallardi, B., Battisti, F., Bisanzi, S., Sani, C., Masala, G., Zappa, M., & Mantellini, P. (2026). Three-year risk of colorectal cancer by faecal haemoglobin concentration in subjects with a negative FIT. Annali dell’Istituto Superiore Di Sanità, 62(3), 277–284. https://doi.org/10.4415/ANN_26_03_10
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