Colorectal cancer screening participation is highest with immunochemical test


NEW YORK (Reuters Health), Dec 31 - More people participate in colorectal cancer screening with the immunochemical fecal occult blood test (FOBT) than with guaiac-based tests or sigmoidoscopy, Dutch researchers report in the January issue of Gut.

The diagnostic yield is highest with sigmoidoscopy, however.

To determine which strategy is most widely preferred, Dr. L. Hol from Erasmus MC University Medical Center, Rotterdam, and colleagues analyzed participation and diagnosis rates in a study that included 15,011 individuals between the ages of 50 and 72.

Participation rates were highest for immunochemical FOBT (61.5%) and were considerably lower for guaiac-based FOBT (49.5%) and flexible sigmoidoscopy (32.4%), the authors report.

The proportion of tests that showed advanced neoplasia was 7-fold higher in the flexible sigmoidoscopy group (8.0%) than that in the guaiac-based FOBT group (1.1%) and 3.4-fold higher than in the immunochemical FOBT group (2.4%).

Similarly, the diagnostic yield of advanced neoplasia per 100 subjects was highest in the flexible sigmoidoscopy group (2.4 cases), intermediate in the immunochemical FOBT group (1.5 cases), and lowest in the guaiac-based FOBT group (0.6 cases).

"Immunochemical FOBT screening should therefore be strongly preferred over guaiac-based FOBT screening," the investigators conclude.

"Apart from this," the authors say, "it is important to recognize that flexible sigmoidoscopy screening in a first screening round provides a considerably higher diagnostic yield of advanced adenomas and colorectal cancer per 100 invitees than both FOBTs, despite a lower participation rate. This supports the consideration of a dual-mode screening program, offering flexible sigmoidoscopy as first screening method and immunochemical FOBT as an alternative."

Gut 2010;59:62-68.

Last Updated: 2009-12-30 14:48:26 -0400 (Reuters Health)

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