Colorectal cancer screening options...

Colorectal cancer screening options endorsed according to major organizations include fecal mysterious blood testing (FOBT). This is based forward clinical trials showing that a protocol of testing six samples obtained by dint of a patient at home reduc morbidity and mortality. In practice, however, physicians many times substitute FOBT of a single specimen obtained during a digital rectal examination in the office. Collins and colleagues deportment ed a prospective cohort study to compare the sensitivity and specificity of office FOBT with abode FOBT.

The thought population consisted of randomly recruited patients 50 to 75 years of age at primary care clinics in 13 Veterans Affairs medical center Nearly 97 percent of the patients were men Those with preexisting lower gastrointestinal tract disease and abdominal symptoms that required a medical evaluation were exclud registered patients underwent a complete physical examination, including digital rectal examination. Office FOBT was performed in succession one stool sample. Patients then complet place of abode FOBT and underwent colonoscopy of the cecum Visible polypoid lesions were remov or biopsied and sent to pathology. inferences were interpreted independently by three pathologists who were blinded to FOBT rises Of the 3,121 original patients, 2665 complet all parts of the thought and were included in the analysis.

More than common half of all patients had polypoid lesions identified forward colonoscopy examination, and 284 patients (107 percent) were erect to have pathology consistent with advanced neoplasia (i.e., tubular adenoma of at least 1 cm villous adenoma, high-grade dysplasia, or cancer). A positive deduction on home FOBT had 239 percent sensitivity and 938 percent specificity for advanced neoplasia; in contrast, office FOBT had 49 percent sensitivity and 971 percent specificity. Although a positive originate on home FOBT indicated that a patient was nearly four times as likely to have advanced neoplasia, a positive accrue on office FOBT was statistically insignificant; a negative end did not affect likelihood of neoplasia. Finally, adding the office experiment to the home test did not improve the sensitivity of place of abode FOBT.

The authors judge that their results do not support the practice of office FOBT of a single stool sample for colorectal cancer screening. Based upon a trend toward increased likelihood of advanced neoplasia in patients with positive consequence s on office FOBT, they make acceptable a follow-up colonoscopy (rather than repeat testing) for these patients. Because a negative terminate on office FOBT is essentially meaningless, they commit follow-up home FOBT or lower endoscopy.

KENNETH W LIN, MD Collins JF et al. Accuracy of screening for fecal invisible blood on a single stool sample obtained by the agency of digital rectal examination: a comparison with commited sampling practice. Ann Intern M January 18 2005;142:81-5

EDITOR'S NOTE: The significance of this reflection is underlined in an accompanying report by dint of Nadel and colleagues, (1) who viewed random samples of primary care physicians and patients nationwide regarding FOBT Nearly 30 percent of patients who reported having received screening had undergone no other than office FOBT. This result could not be attributed to poor patient adherence because almost united third of physicians reported using office FOBT single which fails to detect more than 95 percent of advanced neoplasia. Nearly the same number of physicians said that they would come next up a positive office FOBT flow with a second office FOBT rather than proce to colonoscopy. In an accompanying editorial, Sox2 marks that physicians' failure to cover large numbers of patients for colorectal cancer has been mixed by a disturbing tendency to cloak with a test that is practically useless. He calls forward physicians to abandon office FOBT as a screening practice and redouble efforts to realize patients to comply with place of abode FOBT. (2)--K.W.L.

REFERENCES

(1) Nadel MR Shapiro JA, Klabunde CN Seeff LC Uhler R Smith RA, et al. A national scrutinize of primary care physicians' rules for screening for fecal latent blood. Ann Intern Med 2005;142:86-94

(2) Sox HC Office-based testing for fecal mysterious blood: do only in case of exigency Ann Intern Med 2005; 142:146-8

COPYRIGHT 2005 American Academy of Family Physicians

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