Screening for colorectal cancer with an immunological faecal occult blood test: 2-Year follow-up

Robinson, Michael H.; Marks, C. G.; Farrands, P. A.; Bostock, K.; Hardcastle, J. D.

doi:10.1002/bjs.1800830420

Cited by 20 publications

(5 citation statements)

References 6 publications

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“…If our results are confirmed, they would have important implications for colorectal cancer screening. Firstly, the very low sensitivity of the Haemoccult test could lead to research on other screening tests, such as immunological FOBT, which is expected to be more sensitive (Allison et al, 1996;Robinson et al, 1996;Nakama et al, 1996). Sensitivity of other methods still would need to be assessed by rigorous methods and their costs considered.…”

Section: Discussionmentioning

confidence: 99%

Colorectal cancer mass-screening: Estimation of faecal occult blood test sensitivity, taking into account cancer mean sojourn time

et al. 1997

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Section: Discussionmentioning

confidence: 99%

Colorectal cancer mass-screening: Estimation of faecal occult blood test sensitivity, taking into account cancer mean sojourn time

et al. 1997

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“…Most of the research into FOB test screening has been carried out using a guaiac-based test that detects the peroxidase activity of hemoglobin and is thus an indirect measure of blood loss in stool [1]. Immunological tests that are specific for human hemoglobin are available [1,2], but, to date, these have not been evaluated in a population screening randomized trial.…”

Section: Fob Testingmentioning

confidence: 99%

Methods and Economic Considerations: Group 1 Report

Steele¹,

Gnauck²,

Hrčka³

et al. 2004

Endoscopy

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IntroductionVarious modalities have been proposed for population screening in colorectal cancer, including fecal occult blood (FOB) testing, digital rectal examination, barium enema, rigid and flexible sigmoidoscopy, and colonoscopy. Of these, the only tests that have been studied sufficiently to warrant consideration are the guaiac-based FOB test, flexible sigmoidoscopy, and colonoscopy. In this report we consider the evidence relating to these three approaches and present an economic analysis of them, and, lastly, draw some general conclusions.The biases inherent in screening can only be reliably eliminated by population-based randomized trials where the diseasespecific mortality in the whole population offered screening (including refusers and those who develop interval cancers after a negative test) is compared with that in the population not offered screening. Thus, for the purposes of examining the efficacy of the different screening methods, emphasis has been placed on evidence from such trials. FOB TestingMost of the research into FOB test screening has been carried out using a guaiac-based test that detects the peroxidase activity of hemoglobin and is thus an indirect measure of blood loss in stool [1]. Immunological tests that are specific for human hemoglobin are available [1, 2], but, to date, these have not been evaluated in a population screening randomized trial.Three randomized trials of FOB test screening have reported mortality data: one from Minnesota, USA that was essentially a volunteer study [3], and two true population-based trials, one from Funen, Denmark [4] and the other from Nottingham, England [5]. All these trials showed a significant reduction in colorectal cancer mortality. A meta-analysis, which included additional data from French and Swedish studies, has indicated that the likely magnitude of the reduction in mortality is 16 %, rising to 23 % when adjusted for compliance [6]. Furthermore, evidence from the Minnesota study, which is the longest running of the randomized trials, indicates that FOB test screening may reduce the incidence of colorectal cancer presumably because of the detection and removal of adenomatous polyps [7]. On the basis of these results, the UK government commissioned a demonstration pilot of FOB test screening to establish whether or not the introduction of a national screening program would be feasible [8]. This is now complete, and the results of the independent evaluation are favorable [9].However, the FOB test is far from the perfect screening test. The interval cancer rates in the Funen and Nottingham trials suggest that the sensitivity of FOB testing in a screening context is only in the region of 50 %, and although the specificity is high, there is still an appreciable false-positive rate such that around half of all colonoscopies done following a positive FOB test will show no neoplasia [4,5]. Thus there is a need for a more sensitive and specific test, but one which will still have a sufficient acceptability and economic viability for population sc...

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“…The sensitivity for detection of colorectal neoplasia may be increased by rehydration of the standard guaiac test Hemoccult-II,4or by using a more sensitive faecal occult blood test such as the HemoccultSENSA5 6 or the immunochemical test HemeSELECT 78 However, results have always been obtained at the cost of specificity.…”

mentioning

confidence: 99%

Faecal calprotectin levels in a high risk population for colorectal neoplasia

Kronborg

Ugstad²,

Fuglerud³

et al. 2000

Gut

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Background-Faecal concentrations of the protein calprotectin have been found to be elevated in patients with colorectal neoplasia, suggesting that it might be used as a screening tool for colorectal cancer as well as adenomas. Aims-To measure the sensitivity and specificity of faecal calprotectin for the detection of adenomas in high risk individuals undergoing colonoscopy. Also, to investigate between and within stool variability of calprotectin concentrations. Subjects-A total of 814 patients planned for colonoscopy were included for the following indications: positive faecal occult blood test, 25; neoplasia surveillance, 605; newly detected polyp, 130; and family risk, 54. Methods-Two faecal samples from each of two stools were analysed using the PhiCal ELISA test device (Nycomed Pharma AS). Results-Adenoma patients had significantly higher calprotectin levels than normal subjects (median 9.1 (95% confidence interval 7.5-10.1) v 6.6 (5.6-7.4)mg/l). There was no significant decrease in calprotectin levels after polypectomy. Levels in cancer patients were significantly higher than those in all other subgroups (median 17.6 mg/l (11.5-31.0)). With a cut oV limit of 10 mg/l, the sensitivity for cancer was 74% and for adenoma 43%. Corresponding specificity values were 64% for no cancer and 67% for no neoplasia (cancer+adenoma). Specificity varied from 71% for one stool sample to 63% for four samples. Stool variability was small, suggesting that two spots from one stool were as discriminative as two spots from each of two stools. Conclusions-The sensitivity and specificity of faecal calprotectin levels as a marker for colorectal adenoma and carcinoma justifies its use in high risk groups, but specificity is too low for screening of average risk persons. Lack of a decrease in levels after polypectomy may be due to a more widespread leucocyte migration into the intestinal lumen than that at the polyp site, and needs further investigation. (Gut 2000;46:795-800)

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Screening for colorectal cancer with an immunological faecal occult blood test: 2-Year follow-up

Cited by 20 publications

References 6 publications

Colorectal cancer mass-screening: Estimation of faecal occult blood test sensitivity, taking into account cancer mean sojourn time

Colorectal cancer mass-screening: Estimation of faecal occult blood test sensitivity, taking into account cancer mean sojourn time

Methods and Economic Considerations: Group 1 Report

Faecal calprotectin levels in a high risk population for colorectal neoplasia

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