The Appropriateness of Colorectal Cancer Screening by Fecal Occult Blood Tests

The American Journal of Gastroenterology (Impact Factor: 10.76). 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. DOI:10.1111/j.1572-0241.2007.01217.x · 10.76 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. DOI:10.1016/j.clon.2007.07.002 · 3.40 Impact Factor
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    ABSTRACT: Eighty-nine patients who had been treated by ileal resection for Crohn's disease between 1979 and 1984 were included in a prospective cohort follow up to study the natural course of early postoperative lesions. Recurrent lesions were observed endoscopically in the neoterminal ileum within 1 year of surgery in 73% of the patients, although only 20% of the patients had symptoms. Three years after surgery, the endoscopic recurrence rate had increased to 85% and symptomatic recurrence occurred in 34%. The ultimate course of the disease was best predicted by the severity of the early postoperative lesions, as observed at ileoscopy. Clinical parameters that influenced outcome were preoperative disease activity, the indication for surgery, and the number of surgical resections. When patients were stratified for preoperative disease activity, the severity of lesions found at endoscopy remained a strong predictive factor for symptomatic recurrence. In 22 other patients submitted to "curative" ileal resection and ileocolonic anastomosis, the segment to be used as neoterminal ileum was carefully examined during surgery, and two large biopsies were taken before making the anastomosis. An ileoscopy was performed 6 months after surgery. Although all patients had a macroscopically normal neoterminal ileum and 19 had entirely normal biopsies at the time of surgery, 21 patients were found at ileoscopy to have developed ileitis involving a 15-cm segment (range, 4-30 cm), and 20 had unequivocal microscopic lesions on biopsies. These studies suggest that early lesions in the neoterminal ileum after Crohn's resection do not originate from microscopic inflammation present in this bowel segment at the time of surgery. The early postoperative lesions in the neoterminal ileum seem to be a suitable model to study the pathogenesis of Crohn's disease and also to evaluate new therapeutic modalities, either to prevent development of these early lesions or to treat progressive recurrence.
    Gastroenterology 11/1990; 99(4):956-63. · 16.72 Impact Factor
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