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Digital Rectal Examination Versus Spontaneous Passage of Stool for Fecal Occult Blood Testing. South Med J 2012; 105:357-61. [DOI: 10.1097/smj.0b013e31825bfdc5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Clouston K, Katz A, Martens PJ, Sisler J, Turner D, Lobchuk M, McClement S. Does access to a colorectal cancer screening website and/or a nurse-managed telephone help line provided to patients by their family physician increase fecal occult blood test uptake?: A pragmatic cluster randomized controlled trial study protocol. BMC Cancer 2012; 12:182. [PMID: 22607726 PMCID: PMC3495851 DOI: 10.1186/1471-2407-12-182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 04/30/2012] [Indexed: 12/02/2022] Open
Abstract
Background Fecal occult blood test screening in Canada is sub-optimal. Family physicians play a central role in screening and are limited by the time constraints of clinical practice. Patients face multiple barriers that further reduce completion rates. Tools that support family physicians in providing their patients with colorectal cancer information and that support uptake may prove useful. The primary objective of the study is to evaluate the efficacy of a patient decision aid (nurse-managed telephone support line and/or colorectal cancer screening website) distributed by community-based family physicians, in improving colorectal cancer screening rates. Secondary objectives include evaluation of (dis)incentives to patient FOBT uptake and internet use among 50 to 74 year old males and females for health-related questions. Challenges faced by family physicians in engaging in collaborative partnerships with primary healthcare researchers will be documented. Methods/design A pragmatic, two-arm, randomized cluster controlled trial conducted in 22 community-based family practice clinics (36 clusters) with 76 fee-for-service family physicians in Winnipeg, Manitoba, Canada. Each physician will enroll 30 patients attending their periodic health examination and at average risk for colorectal cancer. All physicians will follow their standard clinical practice for screening. Intervention group physicians will provide a fridge magnet to each patient that contains information facilitating access to the study-specific colorectal cancer screening decision aids (telephone help-line and website). The primary endpoint is patient fecal occult blood test completion rate after four months (intention to treat model). Multi-level analysis will include clinic, physician and patient level variables. Patient Personal Health Identification Numbers will be collected from those providing consent to facilitate analysis of repeat screening behavior. Secondary outcome data will be obtained through the Clinic Characterization Form, Patient Tracking Form, In-Clinic Patient Survey, Post-Study Follow-Up Patient Survey, and Family Physician Survey. Study protocol approved by The University of Manitoba Health Research Ethics Board. Discussion The study intervention has the potential to increase patient fecal occult blood test uptake, decrease colorectal cancer mortality and morbidity, and improve the health of Manitobans. If utilization of the website and/or telephone support line result in clinically significant increases in colorectal cancer screening uptake, changes in screening at the policy- and system-level may be warranted. Trial registration Clinical trials.gov identifier NCT01026753
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Affiliation(s)
- Kathleen Clouston
- Department of Family Medicine Research, Faculty of Medicine, University of Manitoba, P228-770, Bannatyne Ave, Winnipeg, MB R3E 0W3, Canada.
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Lee JK, Reis V, Liu S, Conn L, Groessl EJ, Ganiats TG, Ho SB. Improving fecal occult blood testing compliance using a mailed educational reminder. J Gen Intern Med 2009; 24:1192-7. [PMID: 19774423 PMCID: PMC2771232 DOI: 10.1007/s11606-009-1087-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 05/20/2009] [Accepted: 07/16/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths in the United States. Randomized controlled trials have shown that annual screening fecal occult blood testing (FOBT) reduces CRC mortality and incidence. However, patient compliance with FOBT is low. OBJECTIVE To determine whether a mailed educational reminder increases FOBT card return rates and to examine predictors of FOBT compliance. DESIGN Blinded, randomized, controlled trial at the Veteran Affairs Medical Center, San Diego, California. PATIENTS Seven hundred and seventy-five consecutive patients > or =50 years of age referred by their primary care physicians for FOBT. INTERVENTION Patients were randomly assigned to the usual care group or the intervention group. Ten days after picking up the FOBT cards, a 1-page reminder with information related to CRC screening was mailed to the intervention group only. MEASUREMENTS The primary outcome was proportion of returned FOBT cards after 6 months. Patient demographic, clinical characteristics and prior FOBT completed were collected for multivariate regression analysis. RESULTS At 6 months after card distribution, 64.6% of patients in the intervention group returned cards compared with 48.4% in the control group (P < 0.001). Patients who received a mailed reminder (OR 2.02; 95% CI: 1.48-2.74) or have a prior history of returning the FOBT cards (OR 1.87; 95% CI: 1.29-2.70) were more likely to return the FOBT cards. Patients with current or recent illicit drug use were less likely to return the FOBT cards (OR 0.26; 95% CI: 0.13-0.50). CONCLUSION A simple mailed educational reminder significantly increases compliance with FOBT for CRC screening.
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Affiliation(s)
- Jeffrey K. Lee
- Department of Medicine, VA San Diego Healthcare System and University of California, San Diego, CA USA
| | - Veronica Reis
- Laboratory Medicine, VA San Diego Healthcare System and University of California, San Diego, CA USA
| | - Shanglei Liu
- Department of Medicine, VA San Diego Healthcare System and University of California, San Diego, CA USA
| | - Lorraine Conn
- Laboratory Medicine, VA San Diego Healthcare System and University of California, San Diego, CA USA
| | - Erik J. Groessl
- Family Medicine, VA San Diego Healthcare System and University of California, San Diego, CA USA
| | - Theodore G. Ganiats
- Family Medicine, VA San Diego Healthcare System and University of California, San Diego, CA USA
| | - Samuel B. Ho
- Department of Medicine, VA San Diego Healthcare System and University of California, San Diego, CA USA
- Gastroenterology (111D), VA San Diego Healthcare System, 3550 La Jolla Village Drive, San Diego, CA 92161 USA
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Park SM, Kim SY, Earle CC, Jeong SY, Yun YH. What is the most cost-effective strategy to screen for second primary colorectal cancers in male cancer survivors in Korea? World J Gastroenterol 2009; 15:3153-60. [PMID: 19575496 PMCID: PMC2705739 DOI: 10.3748/wjg.15.3153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 05/23/2009] [Accepted: 05/30/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To identify a cost-effective strategy of second primary colorectal cancer (CRC) screening for cancer survivors in Korea using a decision-analytic model. METHODS A Markov model estimated the clinical and economic consequences of a simulated 50-year-old male cancer survivors' cohort, and we compared the results of eight screening strategies: no screening, fecal occult blood test (FOBT) annually, FOBT every 2 years, sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years (COL10), every 5 years (COL5), and every 3 years (COL3). We included only direct medical costs, and our main outcome measures were discounted lifetime costs, life expectancy, and incremental cost-effectiveness ratio (ICER). RESULTS In the base-case analysis, the non-dominated strategies in cancer survivors were COL5, and COL3. The ICER for COL3 in cancer survivors was $5593/life-year saved (LYS), and did not exceed $10,000/LYS in one-way sensitivity analyses. If the risk of CRC in cancer survivors is at least two times higher than that in the general population, COL5 had an ICER of less than $10,500/LYS among both good and poor prognosis of index cancer. If the age of cancer survivors starting CRC screening was decreased to 40 years, the ICER of COL5 was less than $7400/LYS regardless of screening compliance. CONCLUSION Our study suggests that more strict and frequent recommendations for colonoscopy such as COL5 and COL3 could be considered as economically reasonable second primary CRC screening strategies for Korean male cancer survivors.
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Agostinelli C, Piccaluga PP, Went P, Rossi M, Gazzola A, Righi S, Sista T, Campidelli C, Zinzani PL, Falini B, Pileri SA. Peripheral T cell lymphoma, not otherwise specified: the stuff of genes, dreams and therapies. J Clin Pathol 2008; 61:1160-7. [PMID: 18755717 PMCID: PMC2582342 DOI: 10.1136/jcp.2008.055335] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripheral T cell lymphomas (PTCL) account for about 12% of lymphoid tumours worldwide. Almost half show such morphological and molecular variability as to hamper any further classification, and to justify their inclusion in a waste-basket category termed “not otherwise specified (NOS)”. The latter term is used for neoplasms with aggressive presentation, poor response to therapy and dismal prognosis. In contrast to B cell lymphomas, PTCL have been the subject of only a limited number of studies to elucidate their pathobiology and identify novel pharmacological approaches. Herewith, the authors revise the most recent contributions on the subject based on the experience they have gained in the extensive application of microarray technologies. PTCL/NOS are characterised by erratic expression of T cell associated antigens, including CD4 and CD52, which have recently been proposed as targets for ad hoc immunotherapies. PTCL/NOS also show variable Ki-67 marking, with rates >80% heralding a worse prognosis. Gene expression profiling studies have revealed that PTCL/NOS derive from activated T lymphocytes, more often of the CD4+ type, and bear a signature composed of 155 genes and related products that play a pivotal role in cell signalling transduction, proliferation, apoptosis and matrix remodelling. This observation seems to pave the way for the use of innovative drugs such as tyrosine kinase and histone deacetylase inhibitors whose efficacy has been proven in PTCL primary cell cultures. Gene expression profiling also allows better distinction of PTCL/NOS from angioimmunoblastic T cell lymphoma, the latter being characterised by follicular T helper lymphocyte derivation and CXCL13, PD1 and vascular endothelial growth factor expression.
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Affiliation(s)
- C Agostinelli
- Department of Haematology and Clinical Oncology L and A Seràgnoli, Bologna University School of Medicine, Bologna, Italy
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DeBourcy AC, Lichtenberger S, Felton S, Butterfield KT, Ahnen DJ, Denberg TD. Community-based preferences for stool cards versus colonoscopy in colorectal cancer screening. J Gen Intern Med 2008; 23:169-74. [PMID: 18157581 PMCID: PMC2359177 DOI: 10.1007/s11606-007-0480-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 11/06/2007] [Accepted: 11/29/2007] [Indexed: 12/29/2022]
Abstract
BACKGROUND In the United States, compliance with colorectal cancer (CRC) screening recommendations remains suboptimal. Professional organizations advocate use of shared decision making in screening test discussions, but strategies to facilitate informed choice in CRC screening have not been well elucidated. OBJECTIVE The objectives of the study were to determine screening test preference among colonoscopy-naïve adults after considering a detailed, written presentation of fecal occult blood testing (FOBT) and colonoscopy and to assess whether their preferences are associated with demographic characteristics, attitudes, and knowledge. DESIGN The design of the study was a cross-sectional survey. PARTICIPANTS Colonoscopy-naïve supermarket shoppers age 40-79 in low- and middle-income, multiethnic neighborhoods in Denver, CO, reviewed a detailed, side-by-side description of FOBT and colonoscopy and answered questions about test preference, strength of preference, influence of physician recommendation, basic knowledge of CRC, and demographic characteristics. MEASUREMENTS AND MAIN RESULTS Descriptive statistics characterized the sample, and bivariate and multivariable logistic regression analyses identified correlates of screening test preference. In a diverse sample of 323 colonoscopy-naïve adults, 53% preferred FOBT, and 47% preferred colonoscopy for CRC screening. Individuals of Latino ethnicity and those with lower educational attainment were more likely to prefer FOBT than non-Latino whites and those with at least some college. Almost half of the respondents felt "very strongly" about their preferences, and one third said they would adhere to their choice regardless of physician recommendation. CONCLUSION After considering a detailed, side-by-side comparison of the FOBT and colonoscopy, a large proportion of community-dwelling, colonoscopy-naïve adults prefer FOBT over colonoscopy for CRC screening. In light of professional guidelines and time-limited primary care visits, it is important to develop improved ways of facilitating informed patient decision making for CRC screening.
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Affiliation(s)
- Ann C DeBourcy
- Department of Medicine, University of Colorado at Denver School of Medicine, Aurora, CO 80045, USA
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Digital fecal occult blood testing in the ambulatory urology clinic. J Am Coll Surg 2007; 206:144-7. [PMID: 18155580 DOI: 10.1016/j.jamcollsurg.2007.06.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 06/12/2007] [Accepted: 06/18/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study was designed to evaluate the use and yield of fecal occult blood testing (FOBT) in an ambulatory urology clinic. STUDY DESIGN Patients seen in the ambulatory urology clinic were prospectively evaluated with FOBT. The test was performed only on patients when a rectal examination was indicated as part of their urologic evaluation. Patients who were found to have a positive FOBT were then referred for additional gastrointestinal evaluation. RESULTS One hundred eight patients were evaluated, including 57 men and 51 women. Eight patients (7%), including six men and two women, were found to be positive for fecal occult blood. Two patients were found to have upper gastrointestinal sources of bleeding (one gastritis with Barrett's esophagitis and one with a duodenal ulcer). Two patients had benign lower gastrointestinal sources of bleeding, including one with hyperplastic polyps and one with a tubular adenoma. One patient was diagnosed with a moderately differentiated adenocarcinoma of the sigmoid colon. One had negative followup fecal occult blood test, and two were lost to followup. CONCLUSIONS Addition of FOBT to routine digital rectal examination performed in the ambulatory urology clinic is an inexpensive and simple test that can detect otherwise asymptomatic underlying gastrointestinal pathology. Although the six-sample test is a preferred test for colorectal cancer screening, a digital FOBT during routine urologic evaluation can detect a clinically significant upper or lower gastrointestinal lesion, at the same time increase compliance with FOBT. Larger, prospective studies are needed to confirm the benefit of digital FOBT during a routine urologic visit.
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Shastri YM, Naumann M, Oremek GM, Hanisch E, Rösch W, Mössner J, Caspary WF, Stein JM. Prospective multicenter evaluation of fecal tumor pyruvate kinase type M2 (M2-PK) as a screening biomarker for colorectal neoplasia. Int J Cancer 2006; 119:2651-6. [PMID: 16929517 DOI: 10.1002/ijc.22243] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Proliferating cells, particularly the tumor cells, express a dimeric isoenzyme of pyruvate kinase, termed M2-PK. It's a direct target of several oncoproteins; the determination of fecal tumor pyruvate kinase type M2 (M2-PK) might be another promising tool for colorectal cancer (CRC) screening. In this study, we have evaluated fecal M2-PK as a screening biomarker for colorectal neoplasia. It was compared against fecal occult blood (FOB) and colonoscopy. Three hundred and seventeen consecutive subjects from 4 different centers were included. Stool specimens were collected before purgation, processed appropriately and were tested for FOB and quantitatively analyzed for M2-PK. Colonoscopies were performed by experienced endoscopists who were unaware of fecal assay results. At cutoff value of 4 U/ml, fecal M2-PK assay had a sensitivity, specificity, PPV and NPV of 81.1, 86.7, 71.1 and 61.9% respectively for diagnosing CRC whereas FOBT showed a sensitivity of 36.5%, specificity of 92.2%, PPV of 72.9% and NPV of 71.5% for CRC. Such low specificity of fecal M2-PK will lead to unacceptably high number of false positives if it is used for mass CRC screening, leading to unindicated colonoscopies with its associated inconveniences, risks and costs. CRC screening test must have high specificity; a high sensitivity is not as vital. To conclude, M2-PK was found to be a poor screening biomarker for CR neoplasia in a subject population at above average risk based on its prospective comparison with colonoscopy. These marginal performance characteristics do not permit its use as a screening tool for CR neoplasia in present clinical settings.
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Affiliation(s)
- Yogesh M Shastri
- Department of Medicine I-ZAFES, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany
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Park SM, Yun YH, Kwon S. Feasible economic strategies to improve screening compliance for colorectal cancer in Korea. World J Gastroenterol 2005; 11:1587-93. [PMID: 15786532 PMCID: PMC4305936 DOI: 10.3748/wjg.v11.i11.1587] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: While colorectal cancer (CRC) is an ideal target for population screening, physician and patient attitudes contribute to low levels of screening uptake. This study was carried out to find feasible economic strategies to improve the CRC screening compliance in Korea.
METHODS: The natural history of a simulated cohort of 50-year-old Korean in the general population was modeled with CRC screening until the age of 80 years. Cases of positive results were worked up with colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Baseline screening compliance without insurance coverage by the national health insurance (NHI) was assumed to be 30%. If NHI covered the CRC screening or the reimbursement of screening to physicians increased, the compliance was assumed to increase. We evaluated 16 different CRC screening strategies based on Markov model.
RESULTS: When the NHI did not cover the screening and compliance was 30%, non-dominated strategies were colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). In all scenarios of various compliance rates with raised coverage of the NHI and increased reimbursement of colonoscopy, COL10, COL5 and COL3 were non-dominated strategies, and COL10 had lower or minimal incremental medical cost and financial burden on the NHI than the strategy of no screening. These results were stable with sensitivity analyses.
CONCLUSION: Economic strategies for promoting screening compliance can be accompanied by expanding insurance coverage by the NHI and by increasing reimbursement for CRC screening to providers. COL10 was a cost-effective and cost saving screening strategy for CRC in Korea.
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Affiliation(s)
- Sang Min Park
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
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Stokamer CL, Tenner CT, Chaudhuri J, Vazquez E, Bini EJ. Randomized controlled trial of the impact of intensive patient education on compliance with fecal occult blood testing. J Gen Intern Med 2005; 20:278-82. [PMID: 15836533 PMCID: PMC1490069 DOI: 10.1111/j.1525-1497.2005.40023.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Randomized controlled trials have demonstrated that fecal occult blood testing (FOBT) reduces colorectal cancer (CRC) mortality. However, patient compliance with FOBT is low and this is one of the major barriers to CRC screening. OBJECTIVE To determine whether intensive patient education increases FOBT card return rates. DESIGN Randomized controlled trial. SETTING Department of Veterans Affairs primary care clinic. PARTICIPANTS Seven hundred eighty-eight patients who were referred for FOBT. INTERVENTIONS Patients were randomly allocated to receive either intensive (n=396) or standard (n=392) patient education. Patients in the intensive education group received a one-on-one educational session by primary care nurses on the importance of CRC screening, were instructed on how to properly collect stool specimens for FOBT, and were given a 2-page handout on CRC screening. Patients in the standard education group only received the FOBT cards and written instructions from the manufacturer on how to properly collect stool specimens for FOBT. RESULTS Patients in the intensive education group were more likely to return the FOBT cards (65.9% vs 51.3%; P<.001) and called the clinic with additional questions less often (1.5% vs 5.9%; P=.001) than the standard education group. The median time to return the FOBT cards was significantly shorter in the intensive education group (36 vs 143 days; P<.001 by log-rank test). However, the proportion of patients who had a positive FOBT did not differ in the two groups (4.6% vs 6.0%; P=.51). CONCLUSIONS Intensive patient education significantly improved patient compliance with FOBT. Future studies to evaluate additional educational strategies to further improve patient compliance with CRC screening are warranted.
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Affiliation(s)
- Charlene L Stokamer
- Department of Patient Services/Nursing, VA New York Harbor Healthcare System, New York, NY 10010, USA
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Abstract
Colorectal cancer can be cured and, in some cases, even prevented if detected early through screening. Studies have demonstrated that regular screening for colorectal cancer with fecal occult blood testing, sigmoidoscopy, or colonoscopy can reduce mortality from this disease. Unfortunately, rates of participation in these screening tests are unacceptably low among the U.S. population. Nurses have a significant role to play in assisting individuals to incorporate regular colorectal cancer screening into their health maintenance routines.
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Affiliation(s)
- Susan M Rawl
- Indiana University School of Nursing, 1111 Middle Drive, NU 338, Indianapolis, IN 46202, USA.
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Affiliation(s)
- S A Chamberlain
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Greenberg PD, Bertario L, Gnauck R, Kronborg O, Hardcastle JD, Epstein MS, Sadowski D, Sudduth R, Zuckerman GR, Rockey DC. A prospective multicenter evaluation of new fecal occult blood tests in patients undergoing colonoscopy. Am J Gastroenterol 2000; 95:1331-8. [PMID: 10811348 DOI: 10.1111/j.1572-0241.2000.02032.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Guaiac-based fecal occult blood (FOB) tests, in particular, Hemoccult II (HO), are commonly used to detect colorectal neoplasia. Because the sensitivity and specificity of these tests are critical to cost-effective screening programs, we aimed to investigate the improved performance characteristics of new FOB tests for known colonic lesions. METHODS Nine centers worldwide performed FOB testing with guaiac-based tests (Hemoccult II [HO] and Hemoccult II SENSA [SENSA]) and immunochemical tests (HemeSelect [HS] and FlexSure OBT [FS]) on 554 patients referred for colonoscopy for predetermined indications. A combination testing strategy consisting of SENSA followed by HS or FS (which was considered positive only when both tests were positive) was also evaluated. Results of FOB tests were compared to findings on colonoscopy. RESULTS Cancers were identified in 2.9% of subjects, whereas adenomas > or =10 mm were found in 39 patients. Small adenomas, colitis, and other lesions were identified in 141 patients. The positivity rate of HO for adenomas > or =10 mm was less than for SENSA (20.5% vs 35.9%, p < 0.05), whereas the positivity rate of HO, SENSA, FS, HS, or the combination tests for cancers was not statistically different. The overall positivity rates were significantly greater for FS (15.9%, p = 0.0002) and significantly lower using the combination tests (SENSA/FS 6.0%, p = 0.01; SENSA/HS 6.2%, p = 0.02) compared to HO (9.4%). In this study population, the relative specificity (i.e., true-negative tests/true-negatives + false-positives in patients without adenomas > or =10 mm or cancers) of HO (93.9%; 95% CI, 91.7-96.1) was similar to that of SENSA (92.8%; 95% CI, 90.4-95.2) and HS (90.1%; 95% CI, 87.4-92.8), and greater than FS (88.0%; 95% CI, 85.1-90.9, p < 0.001). When considering adenomas > or =10 mm, cancers alone or cancers and adenomas combined, the combination test using SENSA/FS was associated with significantly fewer false-positive tests than any of the individual tests. CONCLUSIONS Compared to single tests, the combination test with the highly sensitive SENSA and an immunochemical test had slightly reduced sensitivity but significantly fewer false-positive tests than any single test. These data raise the possibility that a combination test (i.e., highly sensitive guaiac plus immunochemical) could reduce the costs of screening for colon cancer, and suggest that further study of combination test strategies is warranted.
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Abstract
Colorectal cancer is an important problem in the United States, with over 130,000 new cases and 55,000 deaths each year. There is now strong evidence that screening for colorectal cancer with fecal occult blood testing can decrease mortality, and additional evidence that removing benign adenomas can decrease cancer incidence. Evidence-based screening guidelines depend on colorectal cancer risk. Individuals at higher risk because of a personal or family history deserve more intensive screening than asymptomatic individuals over age 50.
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Affiliation(s)
- J F Helm
- Department of Medicine, University of South Florida, Tampa, USA
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Abstract
The total costs (direct and indirect) associated with the operation of an Australian community based screening programme for colorectal cancer (CRC) were estimated. One-year costs of the programme were estimated to be AUS$1 347 948 to screen 24 000 participants. This corresponded to AUS$8868 per polyp and AUS$28 679 per cancer detected. The results presented here are quite favourable compared with the only other Australian screening programme that has reported costs. That programme estimated a cost per cancer detected of AUS$24 233 (adjusted). The recent Australian public health literature has been almost unanimously against recommending the operation of population based CRC screening programmes. More recently, overseas randomized control trials have reported reduced mortality (15 to 33%) as a result of these programmes. Cost data, as presented here combined with the epidemiological evidence, indicate the challenge the Federal Government is now confronted with in formulating policy to control the increasing number of deaths from the disease.
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Affiliation(s)
- J Gow
- Department of Economics, University of New England, Armidale NSW, Australia.
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16
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Affiliation(s)
- D C Rockey
- Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, USA.
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Bini EJ, Rajapaksa RC, Valdes MT, Weinshel EH. Is upper gastrointestinal endoscopy indicated in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy? Am J Med 1999; 106:613-8. [PMID: 10378617 DOI: 10.1016/s0002-9343(99)00125-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE There are no recommendations as to whether endoscopic evaluation of the upper gastrointestinal tract is indicated in asymptomatic patients who have a positive fecal occult blood test and a negative colonoscopy. SUBJECTS AND METHODS All asymptomatic patients with a positive fecal occult blood test who were referred for diagnostic endoscopy were identified. Patient charts, endoscopy records, and pathology reports were reviewed. RESULTS During the 5-year study period, 498 asymptomatic patients with a positive fecal occult blood test and negative colonoscopy were evaluated. An upper gastrointestinal source of occult bleeding was detected in 67 patients (13%), with peptic ulcer disease being the most common lesion identified (8%). Four patients were diagnosed with gastric cancer and 1 had esophageal carcinoma. In addition, 74 patients (15%) had lesions that were not considered a source of occult bleeding; these findings prompted a change in management in 56 patients (11%). Anemia was the only variable significantly associated with having a clinically important lesion identified (multivariate odds ratio = 5.0; 95% confidence interval 2.9 to 8.5; P <0.001). CONCLUSIONS Upper gastrointestinal endoscopy yields important findings in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy. Our data suggest that endoscopic evaluation of the upper gastrointestinal tract should be considered, especially in patients with anemia.
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Affiliation(s)
- E J Bini
- Division of Gastroenterology, New York University Medical Center, Bellevue Hospital, and New York Veterans Affairs Medical Center, 10010, USA
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18
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Nakama H, Kamijo N, Fujimori K, Horiuchi A, Fattah AS, Zhang B. Characteristics of colorectal cancer with false negative result on immunochemical faecal occult blood test. J Med Screen 1996; 3:115-8. [PMID: 8946304 DOI: 10.1177/096914139600300302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES A comparative study was carried out to clarify the clinicopathological features of colorectal cancer diagnosed after a false negative result on the immunochemical faecal occult blood test. METHODS 236 patients with colorectal cancer were studied: 48 patients with negative results and 188 patients with positive results with the faecal occult blood test. The two groups were compared according to their age and sex and by the site, size, macroscopic type, Dukes's classification, and histological type of their cancer lesions. Additionally, the above factors were investigated prospectively and compared in 40 cases of colorectal cancer cases diagnosed as false negative and in matched cases diagnosed as true positive in cancer screening by the immunochemical faecal occult blood test. RESULTS In both the hospital based case-control study and the screening programme based nested case-control study the prevalence of rectal cancers was higher in the false negative group than in the true positive group (P = 0.02, P = 0.03), but there were no differences between the two groups for any other factors. CONCLUSION These results suggest that the immunochemical faecal occult blood test is unsuitable for the diagnosis of rectal cancer.
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Affiliation(s)
- H Nakama
- Department of Public Health, Shinshu University School of Medicine, Japan
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Abstract
BACKGROUND This study was undertaken to evaluate whether genetic analysis in the stool can be useful for detecting malignant tumors in the colon and rectum. We searched for the possible presence of mutations in the p53 gene in the stool of patients with resectable colorectal cancer. Alterations in the p53 gene are the most frequent among mutant genes related to colorectal cancer. METHODS Surgically resected tumor specimens and stool samples from 25 patients with colorectal cancer were examined for mutations of exons 5-8 of the p53 gene by polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP). Results were compared with those achieved by fecal occult blood testing. RESULTS Mutations of the p53 gene were found in the tumor tissues in 11 of 25 patients (44%). Of these 11 patients, 7 (64%) had evidence of alterations in the p53 gene within the stool. Of five patients who were negative for fecal occult blood testing, p53 mutations in the stool were evident in three patients. CONCLUSIONS This method of stool DNA analysis for tumor-specific mutations is expected to have a wide application in clinical screening for colorectal cancer.
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Affiliation(s)
- S Eguchi
- Department of Surgery II, Nagasaki University, School of Medicine, Japan
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Abstract
Colorectal cancer is a major cause of morbidity and mortality in the United States. Early detection of the disease at an asymptomatic stage by screening holds promise for lowering the incidence of colorectal cancer deaths, yet compliance with screening guidelines is poor. Evidence in support of the use of screening techniques for colorectal cancer is accumulating, however, and screening for this disease with fecal occult blood tests and flexible sigmoidoscopy can increase the likelihood of early detection, can decrease mortality and morbidity, and can be cost effective.
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Affiliation(s)
- B Levin
- Division of Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA
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Shamsuddin AM, Sakamoto K. Carbohydrate tumor marker: basis for a simple test for colorectal cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1994; 354:85-99. [PMID: 8067291 DOI: 10.1007/978-1-4899-0939-8_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- A M Shamsuddin
- Department of Pathology, University of Maryland School of Medicine, Baltimore 21201
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Affiliation(s)
- B Levin
- Department of Gastrointestinal Oncology and Digestive Diseases, University of Texas M. D. Anderson Cancer Center, Houston 77030
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