SCREENING FOR COLORECTAL CANCER USING THE FECAL OCCULT BLOOD TEST: AN ACTUARIAL ASSESSMENT OF THE IMPACT OF A POPULATION-BASED SCREENING PROGRAM IN CANADA

2003 ◽  
Vol 19 (4) ◽  
pp. 715-723 ◽  
Author(s):  
Paul J. Villeneuve ◽  
Ann Coombs
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Occult Blood ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Fecal Occult ◽  
The Impact

Objectives:A series of randomized controlled trials have demonstrated that screening for colorectal cancer (CRC) using the fecal occult blood (FOB) test can decrease mortality from this disease. These findings were used to develop an actuarial model to estimate the impact that a FOB screening program for colorectal cancer would have on the Canadian population.Methods:The mortality experience of the year 2000 cohort of Canadians fifty to seventy-four years of age, with follow-up extending to 2010, was modelled according to three scenarios: no screening, annual screening, biennial screening. The primary screening tool was the FOB test using unrehydrated samples, with follow-up of positive test results using colonoscopy. The framework of the model was developed based on published findings from the relevant randomized controlled trials, available data, and a literature review that yielded parameter values for some model items.Results:During the 10-year follow-up of the cohort, we estimated that 4,444 and 2,827 deaths would be averted with annual and biennial FOB screening, respectively. We estimated that for an annual FOB screening program, approximately 3,400 FOB tests would be required to prevent one death, whereas 2,700 tests would be required within a biennial program.Conclusions:Our analysis documents the population health impact of using the FOB test to screen for CRC. Additional information on the natural history of the disease, and Canadian pilot data are needed to better model the effectiveness of population-based FOB screening programs.

scholarly journals Delayed Colonoscopy Following a Positive Fecal Test Result and Cancer Mortality

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Anath A Flugelman ◽  
Nili Stein ◽  
Ori Segol ◽  
Idit Lavi ◽  
Lital Keinan-Boker
Keyword(s):  
Positive Result ◽  
Screening Program ◽  
Occult Blood ◽  
Population Based ◽  
Primary Outcome Measure ◽  
Delay Group ◽  
Screening Strategy ◽  
Fecal Occult Blood ◽  
Fecal Occult

Abstract Background A fecal test followed by diagnostic colonoscopy for a positive result is a widely endorsed screening strategy for colorectal cancer (CRC). However, the relationship between the time delay from the positive test to the follow-up colonoscopy and CRC mortality has not been established. Methods From a population-based screening program, we identified CRC patients newly diagnosed from 2005 through 2015 by a positive fecal occult test followed by a colonoscopy. The primary outcome measure was CRC-specific mortality according to four categories for the time elapsed between the positive result and the subsequent colonoscopy. Results The 1749 patients underwent colonoscopies within 0–3 months (n = 981, 56.1%), 4–6 months (n = 307, 17.5%), 7–12 months (n = 157, 9.0%), and later than 12 months (n = 304, 17.4%). CRC-specific deaths according to exposure groups were: 13.8% (135 of 981) for 0–3 months, 10.7% (33 of 307) for 4–6 months (crude hazards ratio [HR] = 0.74, 95% confidence interval [CI] = 0.51 to 1.14), 11.5% (18 of 157) for 7–12 months (crude HR = 0.83, 95% CI = 0.51 to 1.42), and 22.7% (69 of 304) for longer than 12 months (crude HR = 1.40, 95% CI = 1.04 to 1.90). The only variable that was associated with mortality risk was the number of positive slides (P = .003). High positivity was twice the value in the 0–3 as the longer-than-12 months group: 51.9% vs 25.0% and similar for the 4–6 and 7–12 months groups (38.1% and 36.5%), respectively. The adjusted HRs for CRC mortality were 0.81 (95% CI = 0.55 to 1.19); 0.83 (95% CI = 0.50 to 1.41), and 1.53 (95% CI = 1.13 to 2.12, P = .006) for the 4–12, 7–12, and longer-than-12-months groups, respectively, compared with the shortest delay group. Conclusions Among screen-diagnosed CRC patients, performance of colonoscopy more than 12 months after the initial positive fecal occult blood test was associated with more advanced disease and higher mortality due to CRC.

Colorectal Cancer Screening by Fecal Occult Blood Testing: Results of a Population-Based Experience

2000 ◽  
Vol 86 (5) ◽  
pp. 384-388 ◽  
Author(s):  
Grazia Grazzini ◽  
Guido Castiglione ◽  
Antonio Isu ◽  
Paola Mantellini ◽  
Tiziana Rubeca ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Test ◽  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Blood Testing ◽  
Fecal Occult ◽  
Oncological Screening

Aims and background The study evaluated the results of an experimental screening protocol for colorectal cancer by fecal occult blood testing in a municipality of the Province of Florence. Methods A total of 15,235 subjects aged 50–70 years were invited to perform a 1-day immunochemical fecal occult blood testing without any dietary restrictions. All eligible subjects were sent a personal invitation letter, followed by a postal reminder to non-responders. Subjects with a negative stool test were advised to repeat screening after 2 years. Subjects with a positive screening test were invited to undergo full colonoscopy or a combination of left colonoscopy and a double contrast barium enema. Results A total of 6,418 subjects performed the screening test, with an overall compliance of 42.1%. A total of 268 compilers had positive test results. The positivity rate was 4.2%. Detection rate for cancer and for adenomas was 5.1‰ and 11.6‰, respectively. The positive predictive value was 14.3% for cancer and 32.5% for adenoma. A higher compliance was recorded in subjects born in the province of Florence or living in the centre of the town, in married subjects, and in women. The best results in compliance were associated with the direct distribution of fecal occult blood testing kits by general practitioners to their outpatients. Conclusions The study provides useful information about the efficiency and feasibility of a screening program for colorectal cancer using fecal occult blood testing. Compliance results confirm the importance of GP involvement in oncological screening.

scholarly journals Barriers to completing colonoscopy after a positive fecal occult blood test

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Revital Azulay ◽  
Liora Valinsky ◽  
Fabienne Hershkowitz ◽  
Einat Elran ◽  
Natan Lederman ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Screening Program ◽  
Occult Blood ◽  
Opinion Leaders ◽  
Institutional Review Board ◽  
Fecal Occult Blood ◽  
Fecal Occult ◽  
Institutional Review

Abstract Background Colorectal cancer leads to significant morbidity and mortality. Early detection and treatment are essential. Screening using fecal occult blood tests has increased significantly, but adherence to colonoscopy follow-up is suboptimal, increasing CRC mortality risk. The aim of this study was to identify barriers to colonoscopy following a positive FOBT at the level of the patient, physician, organization and policymakers. Methods This mixed methods study was conducted at two health care organizations in Israel. The study included retrospective analyses of 45,281 50–74 year-old members with positive fecal immunochemical tests from 2010 to 2014, and a survey of 772 patients with a positive test during 2015, with and without follow-up. The qualitative part of the study included focus groups with primary physicians and gastroenterologists and in-depth interviews with opinion leaders in healthcare. Results Patient lack of comprehension regarding the test was the strongest predictor of non-adherence to follow-up. Older age, Arab ethnicity, and lower socio economic status significantly reduced adherence. We found no correlation with gender, marital status, patient activation, waiting time for appointments or distance from gastroenterology clinics. Primary care physicians underestimate non-adherence rates. They feel responsible for patient follow-up, but express lack of time and skills that will allow them to ensure adherence among their patients. Gastroenterologists do not consider fecal occult blood an effective tool for CRC detection, and believe that all patients should undergo colonoscopy. Opinion leaders in the healthcare field do not prioritize the issue of follow-up after a positive screening test for colorectal cancer, although they understand the importance. Conclusions We identified important barriers that need to be addressed to improve the effectiveness of the screening program. Targeted interventions for populations at risk for non-adherence, specifically for those with low literacy levels, and better explanation of the need for follow-up as a routine need to be set in place. Lack of agreement between screening recommendations and gastroenterologist opinion, and lack of awareness among healthcare authority figures negatively impact the screening program need to be addressed at the organizational and national level. Trial registration This study was approved by the IRB in both participating organizations (Meuhedet Health Care Institutional Review Board #02–2–5-15, Maccabi Healthcare Institutional Review Board BBI-0025-16). Participant consent was waived by both IRB’s.

scholarly journals Increasing Trend in the Incidence of Colorectal Cancer on Malaysia

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 216s-216s
Author(s):  
N. Ali ◽  
A. Ab Manan
Keyword(s):  
Colorectal Cancer ◽  
Cancer Registry ◽  
Health Informatics ◽  
Screening Program ◽  
Early Stage ◽  
Occult Blood ◽  
Population Based ◽  
Incidence Rates ◽  
Fecal Occult Blood ◽  
Fecal Occult

Background: Colorectal cancer (CRC) is the second most common cancer in Malaysia (13.2%). Aim: To study the epidemiologic trend of colorectal cancer in Malaysia and to suggest the strategy in reducing the incidence of CRC in Malaysia. Methods: Total of 13,693 cases of colorectal cancer diagnosed in 2007-2011 were extracted from the Malaysian National Cancer Registry (MNCR). MNCR is a population-based cancer registry which collects data from all government and private facilities (hospitals, clinics, laboratories, National Registration Department and Health Informatics, MOH) by passive notification and active case findings. The registry registers all new cancer cases among Malaysian citizen diagnosed in Malaysia into CanReg4 software. Data were explored using IARC tools and analyzed using CanReg4 software. Results: 55.8% of the colorectal cancer cases were in male and 44.2% in female. ASR was 14.6 per 100,000 population for male and 11.1 per 100,000 populations for female. The male to female ASR ratio was 1.3:1. The 5-years trend shows increasing incidence for both gender. The age-specific incidence rates of the cases were between 45 to 75 years old. The lifetime risk for males was 1 in 56 and in females was 1 in 74. Majority of the cancer were detected among Chinese followed by Malays and Indians. 66% of the colorectal cancer presented at advanced stage (stage 3 and 4) in males and 65% in female. Conclusion: The trend of colorectal cancer is increasing in Malaysia and most of the cancer cases were diagnosed at late stage. To increase the detection rate of CRC at early stage, Ministry of Health Malaysia has introduce screening program using immunochemical fecal occult blood test (iFOBT) since 2013. Tremendous campaigns also being carry out in the community to create awareness on the importance of colorectal cancer screening for early detection and treatment hence improved the survival.

scholarly journals Adverse events of colonoscopy in a colorectal cancer screening program with fecal immunochemical testing: a population-based observational study

2021 ◽  
Vol 09 (02) ◽  
pp. E224-E232
Author(s):  
Bernard Denis ◽  
Isabelle Gendre ◽  
Sarah Weber ◽  
Philippe Perrin
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Adverse Events ◽  
Colorectal Cancer Screening ◽  
Screening Program ◽  
Occult Blood ◽  
Population Based ◽  
Fecal Occult Blood ◽  
Fecal Occult ◽  
Cancer Screening Program

Abstract Background and study aims The aim of this study was to assess adverse events (AEs) associated with colonoscopy in the French colorectal cancer screening program with fecal occult blood test (FOBT). Patients and methods A retrospective cohort study was performed of all colonoscopies performed from 2015 to 2018 for a positive fecal immunochemical test (FIT) in patients aged 50 to 74 years within the screening program in progress in Alsace, part of the French program. AEs were recorded through prospective voluntary reporting by community gastroenterologists and retrospective postal surveys addressed to individuals screened. They were compared with those recorded in the previous program following colonoscopies performed from 2003 to 2014 for a positive guaiac-based FOBT (gFOBT). Results Of 9576 colonoscopies performed for a positive FIT, 6194 (64.7 %) were therapeutic. Overall, 180 AEs were recorded (18.8 ‰, 95 % CI 16.1–21.5), 114 of them (11.9 ‰, 95 % CI 9.7–14.1) requiring hospitalization, 55 (5.7‰, 95 % CI 4.2–7.3) hospitalization > 24 hours, and eight (0.8 ‰, 95 % CI 0.3–1.4) surgery. The main complications requiring hospitalization were perforation (n = 18, 1.9 ‰, 95 % CI 1.0–2.7) and bleeding (n = 31, 3.2 ‰, 95 % CI 2.1–4.4). Despite a significant increase in several risk factors for complication, the rate of AEs remained stable between gFOBT and FIT programs. Overall, we observed one death (1/27,000 colonoscopies) and three splenic injuries. Conclusions The harms of colonoscopy in a colorectal cancer screening program with FIT are more frequent than usually estimated. This study revealed six AEs requiring hospitalization > 24 hours (three bleeds, two perforations), one necessitating surgery, and 50 minor complications per 1000 colonoscopies.

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