Fecal occult blood and flexible sigmoidoscopy screening for colorectal cancer: Modeling the impact on colonoscopy requirements and cancer detection rates

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.

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Overall evaluation of an immunological latex agglutination system for fecal occult blood testing in the colorectal cancer screening program of Florence

The International Journal of Biological Markers ◽

10.5301/jbm.2012.9343 ◽

2012 ◽

Vol 27 (3) ◽

pp. 195-202 ◽

Cited By ~ 6

Author(s):

Tiziana Rubeca ◽

Benedetta Peruzzi ◽

Massimo Confortini ◽

Stefano Rapi

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Occult Blood ◽

Fecal Occult Blood Testing ◽

Latex Agglutination ◽

Fecal Occult Blood ◽

Detection Rates ◽

Screening Programs ◽

Fecal Occult ◽

Advanced Adenomas

Several immunological fecal occult blood tests (FOBT) are currently available for colorectal cancer (CRC) screening. We compared the HM Jack (Jack) (Kiowa, Japan), with the OC-Hemodia (OC) (Eiken, Japan) in use in the Florence screening program. Aims of the study were: (i) to investigate the diagnostic performance and the best cutoff value for Jack; (ii) to evaluate the handiness of sampling tubes; (iii) to compare costs. A total of 5,044 subjects were screened with both tests. Sampling tube investigation was performed running each sample on both instruments. A number of 352 subjects positive for at least one test (175 OC, 310 Jack) were selected for further investigations, while 46 subjects refused further assessments. Analysis of costs related to the assessment phase was performed on the basis of Tuscany region's fares. Amongst the 306 subjects investigated, 9 CRC and 67 advanced adenomas (AdA) were detected. Detection rates (DR) were 1.4‰ for CRC and 9.6‰ for AdA. After Jack cutoff optimization, DR for CRC+AdA resulted in 11.1‰ for OC and 13.3‰ for Jack (p=0.041). Sensitivity of the methods was 73.7 for OC and 88.2 for Jack; specificity was 97.6 for OC and 96.0 for Jack, resulting in an increase of the required assessments from 3.5% to 5.1%. No differences were observed between sampling methods. Despite the lower specificity of Jack, its greater sensitivity makes the method attractive for screening programs. An increase of the costs of 30% for every subject investigated for pathological lesion (CRC+AdA) may be thus foreseen.

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Screening Strategies for Colorectal Cancer: A Systematic Review of the Evidence

Canadian Journal of Gastroenterology ◽

10.1155/2001/284746 ◽

2001 ◽

Vol 15 (10) ◽

pp. 647-660 ◽

Cited By ~ 24

Author(s):

Robin S McLeod ◽

Keyword(s):

Colorectal Cancer ◽

Flexible Sigmoidoscopy ◽

Occult Blood ◽

Fecal Occult Blood Testing ◽

Fecal Occult Blood ◽

Average Risk ◽

Hereditary Nonpolyposis Colon Cancer ◽

Fecal Occult ◽

Hereditary Nonpolyposis ◽

Asymptomatic Individuals

BACKGROUND: Colorectal cancer is the third most common cancer in Canada. It is well recognized that there are improved survival rates if the disease is treated in its early stages, and indeed this may be a preventable disease. This paper systematically reviews the effectiveness of specific screening techniques for colorectal cancer in asymptomatic individuals at normal or above average risk.METHODS: MEDLINE was searched for articles published between January 1966 and January 2001 by using the MESH terms 'screening' and 'colorectal neoplasia'. The reference sections of review articles published before January 2001 were checked, and content experts were surveyed. The evidence was evaluated using the standardized methodology of the Canadian Task Force on Preventive Health Care.RSULTS AND DISCUSSION: For individuals at normal risk, there is evidence to support the use of annual or biennial fecal occult blood testing and flexible sigmoidoscopy for asymptomatic individuals over age 50 years. The evidence regarding whether only one or both of fecal occult blood testing and sigmoidoscopy should be performed is unclear, as is the evidence regarding the use of colonoscopy as an initial screen. For individuals at above average risk, the evidence supports either genetic testing or flexible sigmoidoscopy of individuals at risk in familial adenomatous polyposis kindreds, and screening with colonoscopy of patients in kindreds with hereditary nonpolyposis colon cancer. The evidence regarding colonoscopy for individuals who have a family history of colorectal polyps or cancer but do not fit the criteria for hereditary nonpolyposis colon cancer is unclear. Development of better risk stratification for screening is a high research priority, and further research, including randomized, controlled trials, into the effectiveness and feasibility of other screening modalities is necessary.

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S1152 Comparing Participants and Non-Participants of a Randomized Colorectal Cancer Screening Program Using Guaiac-Based and Immunochemical Fecal Occult Blood Test and Flexible Sigmoidoscopy

Gastroenterology ◽

10.1016/s0016-5085(10)60868-2 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-191

Author(s):

Leonie van Dam ◽

Ida J. Korfage ◽

Aafke H. van Roon ◽

Lieke Hol ◽

Jacqueline C. Reijerink ◽

...

Keyword(s):

Colorectal Cancer ◽

Blood Test ◽

Fecal Occult Blood Test ◽

Flexible Sigmoidoscopy ◽

Screening Program ◽

Occult Blood ◽

Fecal Occult Blood ◽

Occult Blood Test ◽

Fecal Occult ◽

Cancer Screening Program

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The Use of M2-Pyruvate Kinase as a Stool Biomarker for Detection of Colorectal Cancer in Tertiary Teaching Hospital: A Comparative Study

Annals of Coloproctology ◽

10.3393/ac.2020.08.27 ◽

2020 ◽

Vol 36 (6) ◽

pp. 409-414

Author(s):

Shahidah Che Alhadi ◽

Wan Zainira Wan Zain ◽

Zalina Zahari ◽

Mohd Nizam Md Hashim ◽

Syed Hassan Syed Abd. Aziz ◽

...

Keyword(s):

Colorectal Cancer ◽

Pyruvate Kinase ◽

Cancer Detection ◽

High Sensitivity ◽

Occult Blood ◽

Fecal Occult Blood ◽

Predictive Values ◽

Quick Test ◽

Fecal Occult ◽

Tertiary Teaching

Purpose: Guaiac fecal occult blood test (gFOBT) has been the standard for colorectal screening but it has low sensitivity and specificity. This study evaluated the use of fecal tumor M2-pyruvate kinase (M2-PK) for detection of colorectal cancer and to compare with the current surveillance tool; gFOBT in symptomatic adult subjects underwent colonoscopy.Methods: Stool samples were collected prospectively from symptomatic adults who had elective colonoscopy from September 2014 to January 2016 and were analyzed with the ScheBo M2-PK Quick test and laboratory detection of fecal hemoglobin.Results: The results were correlated to the colonoscopy findings and/or histopathology report. Eighty-five subjects (age of 56.8 ± 15.3 years [mean ± standard deviation]) were recruited with a total of 17 colorectal cancer (20.0%) and 10 colorectal adenoma patients (11.8%). The sensitivity of M2-PK test in colorectal cancer detection was higher than gFOBT (100% vs. 64.7%). M2-PK test had a lower specificity when compared to gFOBT (72.5% vs. 88.2%) in colorectal cancer detection. The positive and negative predictive values were 47.2% and 100% for M2-PK test and 57.9% and 90.9% for gFOBT.Conclusion: Fecal M2-PK Quick test has a high sensitivity for detection of colorectal cancer when compared to gFOBT, making it the potential choice for colorectal tumor screening biomarker in the future.

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