Scientific paper
A critical analysis of the largest reported mass fecal occult blood screening program in the united states

https://doi.org/10.1016/0002-9610(91)90368-NGet rights and content

Abstract

Fecal occult blood testing for the detection of colon cancer remains controversial. We performed a mass screening program from January 24, 1988, to February 19, 1988, with intensive media promotion, including 121 minutes of televised air time. A total of 5,000 primary practitioners were notified by mail. Hemoccult-II tests were distributed to 156,000 individuals; 55,051 (35%) were returned. Ninety-five percent of the respondents were informed of the program by television. A total of 3,375 persons (6%) tested positive for fecal occult blood; of these, 2,469 (73%) informed the center that they saw their physician to initiate a work-up. Information from physicians regarding work-ups was returned on only 1,356 (55%) patients. Diagnostic tests numbered 2,227 (1.6 tests per patient). However, 5% had no testing, 16% had a repeat Hemoccult only, and 35% had neither a barium enema nor colonoscopy performed. Thirtysix colorectal cancers and 212 polyps were identified. The predictive value (i.e., number of cancers per number of patients who tested positive) increased directly by decade. Thirty-three of 36 patients (92%) with cancer underwent either a barium enema or colonoscopy versus only 185 of 438 (42%) patients with a “negative” work-up. Cancers found were carcinoma in situ in 10 patients (29%), Dukes A in 12 (35%), Dukes B in 4 (12%), and Dukes C in 8 (24%); distant metastases were not found in any participant. Thirty-six percent of the tumors were located in either the right or transverse colon. We conclude that: (1) Screening identified early cancers. All were potentially curable and 64% were limited to the bowel wall. (2) Massive Hemoccult distribution was possible over a short interval, but patient and physician compliance was disturbingly low. (3) Total colonic evaluation is mandatory, since at least 36% of tumors were beyond the reach of the flexible sigmoidoscope. (4) Many work-ups were unnecessary (repeat Hemoccults) or inadequate, indicating a need for physician education.

References (30)

  • DP Winchester et al.

    A mass screening program for colorectal cancer using chemical testing for occult blood in the stool

    Cancer

    (1980)
  • SJ Sontag et al.

    Fecal occult blood screening for colorectal cancer in a Veterans Administration hospital

    Am J Surg

    (1983)
  • DP Winchester et al.

    Risks and benefits of mass screening for colorectal neoplasia with the stool guaiac test

    CA

    (1983)
  • A Huffman et al.

    Early detection of bowel cancer at an urban public hospital: demonstration project

    CA

    (1983)
  • KM Cummings et al.

    Screening for colorectal cancer using the Hemoccult-II stool guaiac slide test

    Cancer

    (1984)
  • Cited by (38)

    • Fecal occult blood testing in a general medical clinic: Comparison between guaiac-based and immunochemical-based tests

      2003, American Journal of Medicine
      Citation Excerpt :

      nSure; Enterix Inc., Falmouth, Maine). The 47% compliance rate in this study is similar to reported rates in randomized trials for colorectal cancer screening (5–7) and in the general population (14–17). We were unable to assess whether patients who received guaiac-based tests adhered to instructions for dietary and medication restrictions.

    • Factors that influence the decision to do an adequate evaluation of a patient with a positive stool for occult blood

      2001, American Journal of Gastroenterology
      Citation Excerpt :

      Our data, however, show that the highest percentage of colon cancer (31%) was found in the six-window positive patients who were adequately worked up (Fig. 2). Increasing age has been shown to have an important effect on increasing the rate of cancer detection in our mass screening study, as well as in others (7, 8). Despite this, 19% of the 60-yr-olds in this Boston area study, 26% of the 70-yr-olds, and 32% of the 80-yr-olds (all of whom lived at home) never received any evaluation for their positive stool.

    • Colorectal cancer screening

      1996, Medical Clinics of North America
    View all citing articles on Scopus

    Presented at the 31st Annual Meeting of the Society for Surgery of the Alimentary Tract, San Antonio, Texas, May 15–16, 1990.

    1

    From the Ireland Cancer Center and the Department of Surgery, Case Western Reserve University, Cleveland, Ohio.

    View full text