The appropriateness of colorectal cancer screening by fecal occult blood tests.

The American Journal of Gastroenterology (Impact Factor: 7.55). 04/2008; 103(3):800-1. DOI: 10.1111/j.1572-0241.2007.01612_3.x
Source: PubMed
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    ABSTRACT: National guidelines recommending colorectal cancer (CRC) screening for average risk Canadians were released in 2001. The current study determined rates of CRC screening and predictors of screening 3 yr after the guidelines were released. A population-based random digit dial telephone survey of 1,808 Alberta men and women aged 50-74 yr assessed awareness about, and self-reported rates of, screening. More average risk women than men reported a recent screening with a home fecal occult blood test (FOBT) (14.0%vs 9.8%, P= 0.013) but men had slightly higher rates of screening endoscopy in the past 5 yr (4.3%vs 1.6%, P= 0.003). Overall, only 14.3% of average risk adults (N = 1,476) were up-to-date on CRC screening. Multivariable predictors of being up-to-date on CRC screening differed for men and women although a doctor's recommendation for screening was a strong predictor for both genders (men OR 5.0, 2.9-8.3, women OR 3.8, 2.3-6.5). Screening for other cancers was also an important predictor in both men and women. Three years after the release of national guidelines, rates of screening among average risk adults aged 50-74 yr were very low. Public education programs and primary care interventions to specifically invite average risk adults for screening may be required to increase CRC screening rates.
    The American Journal of Gastroenterology 09/2007; 102(8):1727-35. · 7.55 Impact Factor
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    ABSTRACT: Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. Endoscopic screening is now in favor and its use is increasing, but overall participation rates are poor. A substantial percentage of the population will likely continue to resist endoscopic screening. As such, a noninvasive biomarker for the early detection of CRC remains a priority. Herein, we (i) review the currently available noninvasive screening markers for the early detection of CRC, (ii) discuss newer markers that have undergone preliminary testing, and (iii) introduce and explain potentially promising markers of the future. The published literature on markers for early detection of CRC was identified using a MEDLINE/PubMed search with secondary review of cited publications. Noninvasive testing for CRC is most advanced in testing for stool fecal occult blood, globin, or DNA mutations. Study of abnormal mucins has also been explored. Research for serum-based markers is just beginning and includes serum proteomics, nuclear matrix proteins, and serum DNA testing. Serial guaiac-based fecal occult blood testing (FOBT) is simple, inexpensive, and proven effective at reducing mortality from CRC. Immunochemical fecal occult blood tests facilitate compliance and offer improved specificity, but at increased cost in comparison to FOBT. Fecal DNA testing may provide enhanced sensitivity for detection of CRC in comparison with FOBT, but its high cost limits its use for generalized screening. Rectal mucin testing requires additional evaluation to determine its sensitivity and specificity in comparison with guaiac-based FOBT. Serum tests, such as proteomics, nuclear matrix proteins, and serum DNA, are still in their infancy, but remain a hope for the future.
    The American Journal of Gastroenterology 07/2005; 100(6):1393-403. · 7.55 Impact Factor
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    ABSTRACT: Here we give an overview of colorectal cancer screening strategies with an emphasis on the diagnosis and management of rectal cancer. We review the published studies on screening in the high-risk population, including patients with a history of colorectal cancer, inflammatory bowel disease and inherited conditions. In the average-risk population, the evidence base for a number of screening strategies is evaluated, including endoscopy, contrast studies and faecal occult blood testing. Screening guidelines in the high-risk population are predominantly based on case-control studies comparing the incidence of colorectal cancer in screened and control groups. Screening the average-risk population for colorectal cancer reduces cancer-specific mortality by 15% after biennial guaiac faecal occult blood testing and 50-80% after flexible sigmoidoscopy. All of the screening strategies outlined have a greater sensitivity for distal lesions than proximal lesions.
    Clinical Oncology 12/2007; 19(9):639-48. · 2.86 Impact Factor