Fecal occult blood screening for colorectal cancer in the general population results of a controlled trial

Hardcastle, J. D.; Armitage, N. C.; Chamberlain, Jocelyn; Amar, S. S.; James, Peter; Balfour, T. W.

doi:10.1002/1097-0142(19860715)58:2<397::aid-cncr2820580235>3.0.co;2-x

Cited by 113 publications

(49 citation statements)

References 12 publications

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“…Three such trials are underway in New York [61,70], Minnesota [103. 114], and Nottingham, England [106,115], but longterm prognostic results are not yet available. At the moment, ~herefore, it is not known whether occult blood testing actually improves mortality from colorectal cancer.…”

Section: Opposing Evidencementioning

confidence: 99%

“…Once these growths are uncovered by initial testing, subsequent ongoing surveillance of the same population will yield substantially fewer lesions -reflecting the interval incidence of new growths (along with some lesions missed by the earlier testing). The limited evidence available indicates that interval occult blood testing detects only about one-third the number of colorectal cancers as an initial study of the same population [106,125]. 14ence repeated surveillance, as recommended by the American Cancer Society [20], is much less fruitful than initial population screening, despite similar effort and cost.…”

Section: Opposing Evidencementioning

confidence: 99%

“…Indeed, in most largc studies only about 5%-10% of occult bloodpositive subjects turn out to have colorectal malignancy; i.e., 90%-95% of the reactions are falsely positive for cancer [34]. Figures in the well-designed controlled trials are slightly better than this, but are still only in thc 10% range overall [102,103,106]. The predictive value of a positive test for cancer does rise with thc subject's age and can exceed 20% in people oldcr than 70 [102].…”

Section: Opposing Evidencementioning

confidence: 99%

“…As mentioned abovc, benign colonic adenomas can be detectcd in a substantial additional minority of test-positive individuals -36% in the SloanKettering [12] and 28% in the Nottingham [106] controllcd trials, for example. This increascs the predictive value of a positive tcst for neoplasm, but, as discussed abovc, benign polyps are widely prevalent in thc general population and only rarcly bccome malignant.…”

Section: Opposing Evidencementioning

confidence: 99%

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The pros and cons of fecal occult blood testing for colorectal neoplasms

Simon

1987

Cancer Metast Rev

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Testing feces for occult blood is widely recommended as a means of detecting subclinical colorectal tumors. Guaiac tests such as Hemoccult are the most widely used, but chemical sensitivity is relatively low and the tests are affected by dietary peroxidases, the state of fecal hydration, and certain drugs. The newly devised HemoQuant and immunologic techniques appear more sensitive and specific, but they require further evaluation before widespread clinical usage can be recommended. Occult blood screening has both merits and weaknesses. Testing does uncover subclinical colorectal cancer, often at a relatively early stage, but whether this actually improves the prognosis remains to be proven. Benign neoplastic polyps are also detected, although it is debatable whether this is a valid rationale for screening. Test sensitivity for malignancy varies from good to moderate, but is poor for benign polyps. Specificity is usually around 97%-98%, yet the predictive value of a positive test for cancer is only about 10%; hence most test-positive individuals are needlessly subjected to invasive colonic investigations. Reported figures on public compliance with occult blood testing vary widely from excellent to poor. Published costs of screening are usually quite low, but these overlook important indirect and hidden expenses and are therefore misleading. On balance, the problems of occult blood testing currently appear to outweight the merits. This could change, however, with the newer testing techniques and with awaited mortality data from controlled clinical trials now underway.

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Section: Opposing Evidencementioning

confidence: 99%

Section: Opposing Evidencementioning

confidence: 99%

Section: Opposing Evidencementioning

confidence: 99%

Section: Opposing Evidencementioning

confidence: 99%

See 2 more Smart Citations

The pros and cons of fecal occult blood testing for colorectal neoplasms

Simon

1987

Cancer Metast Rev

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“…Repeated screening by means of the guaiac fecal occult blood test (gFOBT) reduces mortality by 15% to 33%, as shown in several trials. [2][3][4] Since these trials were performed, more sensitive FOBTs have been developed. One new version is the fecal immunochemical test (FIT), which is specific for the detection of human globin in stool.…”

Section: Introductionmentioning

confidence: 99%

Nonbleeding adenomas: Evidence of systematic false‐negative fecal immunochemical test results and their implications for screening effectiveness—A modeling study

Meulen

Lansdorp–Vogelaar

Heijningen

et al. 2016

Cancer

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BACKGROUND: If some adenomas do not bleed over several years, they will cause systematic false-negative fecal immunochemical test (FIT) results. The long-term effectiveness of FIT screening has been estimated without accounting for such systematic falsenegativity. There are now data with which to evaluate this issue. METHODS: The authors developed one microsimulation model (MISCAN [MIcrosimulation SCreening ANalysis]-Colon) without systematic false-negative FIT results and one model that allowed a percentage of adenomas to be systematically missed in successive FIT screening rounds. Both variants were adjusted to reproduce the first-round findings of the Dutch CORERO FIT screening trial. The authors then compared simulated detection rates in the second screening round with those observed, and adjusted the simulated percentage of systematically missed adenomas to those data. Finally, the authors calculated the impact of systematic false-negative FIT results on the effectiveness of repeated FIT screening. RESULTS: The model without systematic false-negativity simulated higher detection rates in the second screening round than observed. These observed rates could be reproduced when assuming that FIT systematically missed 26% of advanced and 73% of nonadvanced adenomas. To reduce the false-positive rate in the second round to the observed level, the authors also had to assume that 30% of false-positive findings were systematically false-positive. Systematic false-negative FIT testing limits the long-term reduction of biennial FIT screening in the incidence of colorectal cancer (35.6% vs 40.9%) and its mortality (55.2% vs 59.0%) in participants. CONCLUSIONS:The results of the current study provide convincing evidence based on the combination of real-life and modeling data that a percentage of adenomas are systematically missed by repeat FIT screening. This impairs the efficacy of FIT screening. INTRODUCTIONColorectal cancer (CRC) is the second most common cause of cancer-related mortality in the Western world. 1 Screening can prevent part of these deaths through early detection and treatment. Repeated screening by means of the guaiac fecal occult blood test (gFOBT) reduces mortality by 15% to 33%, as shown in several trials. [2][3][4] Since these trials were performed, more sensitive FOBTs have been developed. One new version is the fecal immunochemical test (FIT), which is specific for the detection of human globin in stool. Several trials have demonstrated that FIT screening is associated with a higher diagnostic yield and higher adherence compared with gFOBT screening. 5-11 As a consequence, several countries, including Italy, Australia, Japan, and the Netherlands, have adopted population-based FIT screening, 12 whereas in the United States, for example, several local initiatives recently adopted FIT screening. 12,13 New tests always raise the question of whether randomized controlled trials, which are expensive and take at least 10 years before results are produced, are necessary. To our knowledge, the long-term...

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