1Liebermann DA, Weiss DG One-Time Screening for Colorectal Cancer With Combined Fecal Occult-Blood Testing (FOBT) and Examination of the Distal Colon NEJM 2001;345:555–60. Get access to over 12 million other articles!" />
TITLE

Screening for colorectal cancer1 1Liebermann DA, Weiss DG One-Time Screening for Colorectal Cancer With Combined Fecal Occult-Blood Testing (FOBT) and Examination of the Distal Colon NEJM 2001;345:555–60

AUTHOR(S)
Alazmi, Waleed M.; Barkin, Jamie S.
PUB. DATE
July 2002
SOURCE
American Journal of Gastroenterology;Jul2002, Vol. 97 Issue 7, p1837
SOURCE TYPE
Academic Journal
DOC. TYPE
Editorial
ABSTRACT
This report is on the yield of one-time screening for colorectal cancer with combined fecal occult blood tests (FOBTs) and examination of the distal colon. The study population included 2885 subjects without symptoms who underwent one-time FOBT and colonoscopy. The information obtained from the examination of the rectum and sigmoid colon during colonoscopy was used as a surrogate for the results of sigmoidoscopy. The population’s mean age was 63 yr, and 96.8% were male. It was found that 306 patients (10.6%) had advanced neoplasia, which the authors defined as tubular adenoma of >10 mm, adenoma with villous features, high grade dysplasia, or invasive cancer. Positive FOBTs were found in 23.9% (n = 239). The sensitivity of the test for detecting cancer or high grade dysplasia was 35.6%. The positive predictive value of the test for advanced neoplasia was 39.7% and the negative predictive value was 87.8%. The relative risk of having advanced neoplasia when the FOBT is positive was 3.47 with a 95% CI. There was a strong association between number of positive FOBT cards and the presence of advanced neoplasia (p < 0.001). The analysis assumed that if the first test had a positive result, a colonoscopy would be performed. Accordingly, if sigmoidoscopy was performed alone, the total number of endoscopic examinations would be 3451 (instead of 2885). The rate of detecting advanced neoplasia would be 70.3%, and the number of colonoscopic examinations needed to identify one subject with advanced neoplasia would be 2.6. The addition of the FOBT to sigmoidoscopy would identify 75.8% of the subjects with advanced neoplasia, a statistically insignificant increase in the rate of detection. The combined modality would slightly reduce the number of endoscopies (3365 vs 3451 examinations). No correlation was found between age and the frequency of positive FOBTs or age and detection of advanced neoplasia. In the group of subjects with no adenoma in the distal colon but with advanced neoplasia in the proximal colon, the sensitivities of the FOBT decrease with age (p < 0.02).
ACCESSION #
7839762

 

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