Colon Cancer Screening Guidelines 2005: The Fecal Occult Blood Test Option Has Become a Better FIT

The Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation published guidelines on colon cancer screening in 2004. Subsequent to the publication of these guidelines, many advances have occurred, thereby necessitating a review of the existing guidelines in the context of new technologies and clinical knowledge. The assembled guideline panel recognized three recent American sets of guidelines and identified seven issues that required comment from a Canadian perspective. These issues included, among others, the role of program-based screening, flexible sigmoidoscopy, computed tomography colonography, barium enema and quality improvement. The panel also provided context for the selection of the fecal immunochemical test as the fecal occult blood test of choice, and the relative role of colonoscopy as a primary screening tool. Recommendations were also provided for an upper age limit for colon cancer screening, whether upper endoscopy should be performed following a negative colonoscopy for a positive fecal occult blood test and when colon cancer screening should resume following negative colonoscopy.

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Preference and compliance of stool occult blood testing in a rural cancer-screening program

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.1030 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 1030-1030

Author(s):

S. Waheed ◽

T. A. Linthacum

Keyword(s):

Colon Cancer ◽

Cancer Screening ◽

Blood Test ◽

Fecal Occult Blood Test ◽

Occult Blood ◽

Return Rate ◽

Fecal Occult Blood ◽

Occult Blood Test ◽

Fecal Occult ◽

Immunochemical Assay

1030 Background: Colon cancer is the third most common cancer in men and women. Screening for colon cancer reduces the incidence of colon cancer; decreases mortality associated with colon cancer and should be an integral part of all comprehensive cancer screening programs. The impact of patient preference and compliance when given the option between guaiac-based fecal occult smear method and immunochemical assay testing was reviewed at a rural cancer-screening clinic. Methods: All cancer screening participants over age 50 were educated about colon cancer prevention and screening. The immunochemical assay test and the guaiac-based fecal occult blood test directions and costs were thoroughly explained. A sample test packet of the chosen method was shown to the participant for further explanation on the directions. Data was collected for over one year with documentation of type of preference of test taken and the return rates of those tests. Results: A total of 2170 immunochemical assay or guaiac-based fecal occult blood tests were offered to participants over age 50. The total percentage of tests taken was 39% (852 participants). 81% (688 participants) of the participants chose the immunochemical test over the guaiac-based fecal occult blood test 18% (155 participants). The return rate continued in favor of the immunochemical test with 86% (380 participants) return rate as compared with only 14% return rate for guaiac-based fecal occult blood test (60 participants). The total return rate for both test combined was 51%. Conclusion: This study revealed a surprising lack of acceptance of colon caner screening by means of stool occult blood testing despite vast efforts at thorough explanations and education. When occult blood testing was accepted immunochemical assay testing was the preferred method. Further research should focus on patient barriers in accepting colon cancer testing. No significant financial relationships to disclose.

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