{"id":"https://openalex.org/W2913463701","doi":"https://doi.org/10.14309/00000434-201710001-00206","title":"A Lower Hemoglobin Concentration Cutoff for Abnormal Fecal Immunochemical Testing Substantially Increases Colorectal Cancer and Advanced Neoplasia Detection in a System Level Mailed Outreach Program","display_name":"A Lower Hemoglobin Concentration Cutoff for Abnormal Fecal Immunochemical Testing Substantially Increases Colorectal Cancer and Advanced Neoplasia Detection in a System Level Mailed Outreach Program","publication_year":2017,"publication_date":"2017-10-01","ids":{"openalex":"https://openalex.org/W2913463701","doi":"https://doi.org/10.14309/00000434-201710001-00206","mag":"2913463701"},"language":"en","primary_location":{"id":"doi:10.14309/00000434-201710001-00206","doi":"https://doi.org/10.14309/00000434-201710001-00206","is_oa":false,"landing_page_url":"https://doi.org/10.14309/00000434-201710001-00206","pdf_url":null,"source":{"id":"https://openalex.org/S66441642","display_name":"The American Journal of Gastroenterology","issn_l":"0002-9270","issn":["0002-9270","1572-0241"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-2","ki-jl-2","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"American Journal of Gastroenterology","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5079828692","display_name":"Emily Berry","orcid":"https://orcid.org/0000-0002-6727-2663","observed_orcids":["https://orcid.org/0000-0002-6727-2663"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Emily Berry","raw_affiliation_strings":["Moncrief Cancer Institute, Fort Worth, TX","</em>","<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">Moncrief Cancer Institute, Fort Worth, TX"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Moncrief Cancer Institute, Fort Worth, TX","institution_ids":[]},{"raw_affiliation_string":"</em>","institution_ids":[]},{"raw_affiliation_string":"<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">Moncrief Cancer Institute, Fort Worth, TX","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5012180922","display_name":"Stacie Miller","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Stacie Miller","raw_affiliation_strings":["Moncrief Cancer Institute, Fort Worth, TX","</em>","<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">Moncrief Cancer Institute, Fort Worth, TX"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Moncrief Cancer Institute, Fort Worth, TX","institution_ids":[]},{"raw_affiliation_string":"</em>","institution_ids":[]},{"raw_affiliation_string":"<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">Moncrief Cancer Institute, Fort Worth, TX","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5032005299","display_name":"Mark G. Koch","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I2799739429","display_name":"John Peter Smith Hospital","ror":"https://ror.org/01cx85066","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I165139151","https://openalex.org/I2799739429","https://openalex.org/I2802662748"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Mark Koch","raw_affiliation_strings":["John Peter Smith Health Network, Fort Worth, TX;","</em>","<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">John Peter Smith Health Network, Fort Worth, TX"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"John Peter Smith Health Network, Fort Worth, TX;","institution_ids":["https://openalex.org/I2799739429"]},{"raw_affiliation_string":"</em>","institution_ids":[]},{"raw_affiliation_string":"<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">John Peter Smith Health Network, Fort Worth, TX","institution_ids":["https://openalex.org/I2799739429"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5080162581","display_name":"Keith Edward Argenbright","orcid":"https://orcid.org/0000-0001-6775-1229","observed_orcids":["https://orcid.org/0000-0001-6775-1229"]},"institutions":[{"id":"https://openalex.org/I4390039370","display_name":"Harold C. Simmons Comprehensive Cancer Center","ror":"https://ror.org/03cbz4r60","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4390039370","https://openalex.org/I867280407"]},{"id":"https://openalex.org/I867280407","display_name":"The University of Texas Southwestern Medical Center","ror":"https://ror.org/05byvp690","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I867280407"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Keith Argenbright","raw_affiliation_strings":["UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX;","</em>","<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX;","institution_ids":["https://openalex.org/I4390039370","https://openalex.org/I867280407"]},{"raw_affiliation_string":"</em>","institution_ids":[]},{"raw_affiliation_string":"<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX","institution_ids":["https://openalex.org/I4390039370","https://openalex.org/I867280407"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5065779876","display_name":"Bijal A. Balasubramanian","orcid":"https://orcid.org/0000-0003-2844-9048","observed_orcids":["https://orcid.org/0000-0003-2844-9048"]},"institutions":[{"id":"https://openalex.org/I919571938","display_name":"The University of Texas Health Science Center at Houston","ror":"https://ror.org/03gds6c39","country_code":"US","type":"education","lineage":["https://openalex.org/I919571938"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Bijal A. Balasubramanian","raw_affiliation_strings":["University of Texas Health Science Center at Houston, Dallas, TX;","</em>","<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">University of Texas Health Science Center at Houston, Dallas, TX"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Texas Health Science Center at Houston, Dallas, TX;","institution_ids":["https://openalex.org/I919571938"]},{"raw_affiliation_string":"</em>","institution_ids":[]},{"raw_affiliation_string":"<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">University of Texas Health Science Center at Houston, Dallas, TX","institution_ids":["https://openalex.org/I919571938"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5079444927","display_name":"Samir N. Gupta","orcid":"https://orcid.org/0000-0003-4192-5002","observed_orcids":["https://orcid.org/0000-0003-4192-5002"]},"institutions":[{"id":"https://openalex.org/I4210099595","display_name":"VA San Diego Healthcare System","ror":"https://ror.org/00znqwq11","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1322918889","https://openalex.org/I2799886695","https://openalex.org/I4210099595","https://openalex.org/I4210138663"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Samir Gupta","raw_affiliation_strings":["VA San Diego, La Jolla, CA","<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">VA San Diego, La Jolla, CA</em>"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"VA San Diego, La Jolla, CA","institution_ids":["https://openalex.org/I4210099595"]},{"raw_affiliation_string":"<em xmlns:mrws=\"http://webservices.ovid.com/mrws/1.0\">VA San Diego, La Jolla, CA</em>","institution_ids":["https://openalex.org/I4210099595"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":5,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":{"value":4390,"currency":"USD","value_usd":4390},"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.29692847,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"112","issue":null,"first_page":"S108","last_page":"S108"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10552","display_name":"Colorectal Cancer Screening and Detection","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10552","display_name":"Colorectal Cancer Screening and Detection","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11369","display_name":"Genetic factors in colorectal cancer","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2734","display_name":"Pathology and Forensic Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10335","display_name":"Colorectal Cancer Surgical Treatments","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/fecal-immunochemical-test","display_name":"fecal immunochemical test","score":0.9769999980926514},{"id":"https://openalex.org/keywords/colorectal-cancer-screening","display_name":"colorectal cancer screening","score":0.890999972820282},{"id":"https://openalex.org/keywords/advanced-adenoma","display_name":"advanced adenoma","score":0.7429999709129333},{"id":"https://openalex.org/keywords/safety-net-health-system","display_name":"safety-net health system","score":0.8870000243186951},{"id":"https://openalex.org/keywords/uninsured-adults","display_name":"uninsured adults","score":0.8230000138282776},{"id":"https://openalex.org/keywords/colorectal-cancer-detection","display_name":"colorectal cancer detection","score":0.546999990940094},{"id":"https://openalex.org/keywords/colorectal-neoplasms","display_name":"colorectal neoplasia","score":0.6209999918937683}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9134521484375},{"id":"https://openalex.org/C2778435480","wikidata":"https://www.wikidata.org/wiki/Q840387","display_name":"Colonoscopy","level":4,"score":0.7888058423995972},{"id":"https://openalex.org/C526805850","wikidata":"https://www.wikidata.org/wiki/Q188874","display_name":"Colorectal cancer","level":3,"score":0.6849213242530823},{"id":"https://openalex.org/C2777428134","wikidata":"https://www.wikidata.org/wiki/Q272741","display_name":"Adenoma","level":2,"score":0.5742639899253845},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.5570008754730225},{"id":"https://openalex.org/C90924648","wikidata":"https://www.wikidata.org/wiki/Q120569","display_name":"Gastroenterology","level":1,"score":0.4975927174091339},{"id":"https://openalex.org/C2778217198","wikidata":"https://www.wikidata.org/wiki/Q556977","display_name":"Cutoff","level":2,"score":0.4864060878753662},{"id":"https://openalex.org/C41260117","wikidata":"https://www.wikidata.org/wiki/Q668064","display_name":"Hepatology","level":2,"score":0.45298299193382263},{"id":"https://openalex.org/C2781400479","wikidata":"https://www.wikidata.org/wiki/Q11640","display_name":"Outreach","level":2,"score":0.4514330327510834},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.36262309551239014},{"id":"https://openalex.org/C121332964","wikidata":"https://www.wikidata.org/wiki/Q413","display_name":"Physics","level":0,"score":0.0},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.0},{"id":"https://openalex.org/C62520636","wikidata":"https://www.wikidata.org/wiki/Q944","display_name":"Quantum mechanics","level":1,"score":0.0},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.0}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.14309/00000434-201710001-00206","doi":"https://doi.org/10.14309/00000434-201710001-00206","is_oa":false,"landing_page_url":"https://doi.org/10.14309/00000434-201710001-00206","pdf_url":null,"source":{"id":"https://openalex.org/S66441642","display_name":"The American Journal of Gastroenterology","issn_l":"0002-9270","issn":["0002-9270","1572-0241"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-2","ki-jl-2","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"American Journal of Gastroenterology","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":1.0}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2944242521","https://openalex.org/W2742656392","https://openalex.org/W2943956916","https://openalex.org/W2810333993","https://openalex.org/W2942538039","https://openalex.org/W2511567824","https://openalex.org/W2030790825","https://openalex.org/W2944701869","https://openalex.org/W2800521738","https://openalex.org/W3016587774"],"abstract_inverted_index":{"Introduction:":[0],"Non-invasive":[1],"tests":[2],"like":[3],"the":[4,46,176,182,250,258],"fecal":[5,27],"immunochemical":[6],"test":[7],"(FIT)":[8],"are":[9],"more":[10],"acceptable":[11],"but":[12,39,368],"have":[13,387],"lower":[14,26,51,361,402],"sensitivity":[15],"for":[16,32,54,137,195,275,357],"colorectal":[17],"cancer":[18],"(CRC)":[19],"and":[20,60,110,124,204,236,282,293,371,410],"advanced":[21,57,202,280,294,372,384],"adenoma":[22,295,373],"than":[23],"colonoscopy.":[24,162],"A":[25,360],"hemoglobin":[28],"concentration":[29],"([Hgb])":[30],"cutoff":[31,53,263,363],"abnormal":[33,55,140,156,179,245,304,403],"FIT":[34,56,97,117,157,180,222,246,362,398,404],"might":[35],"improve":[36],"neoplasia":[37,58,385],"sensitivity,":[38],"increase":[40],"diagnostic":[41,161,365],"colonoscopy":[42,61,189,268,366,391],"demand.":[43],"We":[44,174],"analyzed":[45],"impact":[47],"of":[48,71,291,315,326,335],"implementing":[49],"a":[50,64,72,95,105,114,151,289,376],"[Hgb]":[52,193,208,272,298,320],"detection":[59,409],"demand":[62],"within":[63,104],"large":[65],"safety-net":[66,106],"health":[67,107,394],"system":[68,73],"as":[69],"part":[70],"level":[74],"mailed":[75,96],"outreach":[76,98],"program.":[77],"Methods:":[78],"The":[79,220],"study":[80],"included":[81,113],"17,017":[82],"uninsured":[83],"patients,":[84],"age":[85,240],"50":[86,149,185,209,252,308],"to":[87,102,133,147,210,306,309,339,406],"64,":[88],"not":[89],"up-to-date":[90],"with":[91,155,171,178,197,244,383],"screening,":[92],"enrolled":[93],"in":[94,380],"program":[99],"from":[100,144],"2014":[101],"2016":[103],"system.":[108],"English":[109],"Spanish":[111],"invitations":[112],"one":[115],"sample":[116],"kit":[118],"(OC":[119],"Sensor,":[120],"Polymedco),":[121],"collection":[122],"instructions,":[123],"postage":[125],"paid":[126],"return":[127],"envelope;":[128],"telephone":[129],"reminders":[130],"were":[131,158,224,303],"used":[132],"promote":[134],"completion.":[135],"Threshold":[136],"defining":[138],"an":[139],"result":[141],"was":[142,216,241,247],"reduced":[143],"\u2265":[145,148,213,251,260,299],"100":[146,183,211,214,261,300,310],"ng/dL":[150,186,215,253,262,311,322],"priori.":[152],"All":[153],"patients":[154,196,382],"offered":[159],"free":[160],"In":[163],"this":[164],"analysis,":[165],"we":[166,191],"focus":[167],"on":[168],"5,838":[169,221],"individuals":[170],"completed":[172],"FIT.":[173],"compare":[175],"proportion":[177],"using":[181,401],"vs.":[184,212,343],"cutoffs.":[187],"Among":[188,265],"completers,":[190],"characterized":[192],"distribution":[194,206],"no":[198],"neoplasia,":[199],"nonadvanced":[200],"adenoma,":[201,203,279,281],"CRC;":[205],"by":[207,329,349],"also":[217],"assessed.":[218],"Results:":[219],"completers":[223],"diverse,":[225],"62.3%":[226],"female;":[227],"37.6%":[228],"white,":[229],"28.3%":[230],"black,":[231],"32.9%":[232],"Hispanic,":[233],"2.4%":[234],"Asian,":[235],"29.8%":[237],"other;":[238],"median":[239,271],"56.":[242],"Proportion":[243,334],"12.3%":[248],"at":[249,257],"cutoff,":[254,378],"or":[255],"6.6%":[256],"standard":[259],"(P=.0013).":[264],"those":[266],"completing":[267],"(640,":[269],"54.0%),":[270],"varied":[273],"significantly":[274],"normal":[276],"colonoscopy,":[277],"non-advanced":[278],"CRC":[283,292,317,370,408],"(p":[284],"trend=0.0037,":[285],"Figure":[286],"1).":[287],"Though":[288],"majority":[290],"cases":[296,318],"had":[297,319],"ng/dL,":[301],"27-33%":[302],"due":[305],"concentrations":[307],"(Figure":[312],"2);":[313],"3":[314,381],"11":[316],"<100":[321],"(Table":[323],"1).Figure:":[324],"Distribution":[325],"Hemoglobin":[327,347],"Concentration":[328],"Most":[330,350],"Advanced":[331,351],"Colonoscopy":[332,352],"Finding.Figure:":[333],"Abnormal":[336],"FITs":[337],"Attributable":[338],"Standard":[340],"(>100":[341],"ng/dL)":[342,346],"Lower":[344],"(50-100":[345],"Cutoff":[348],"Finding.Table:":[353],"Table.":[354],"Patient":[355],"Detail":[356],"CRCs":[358],"DiagnosedConclusion:":[359],"doubled":[364],"demand,":[367],"improved":[369],"detection.":[374],"Using":[375],"higher":[377],"1":[379],"would":[386],"been":[388],"missed.":[389],"If":[390],"capacity":[392],"permits,":[393],"systems":[395],"employing":[396],"quantitative":[397],"should":[399],"consider":[400],"cutoffs":[405],"optimize":[407],"prevention.":[411]},"counts_by_year":[],"updated_date":"2026-10-30T12:39:25.321706","created_date":"2019-02-21T00:00:00"}