The use of fecal recondite blood t...

The use of fecal recondite blood testing has been approveed as a screen for colorectal cancer in patients at average risk. This recommendation is based forward the fact that screening with fecal cabalistic blood testing has been shown to render mortality from colorectal cancer through 15 to 33 percent. The standard guaiac-based fecal shrouded blood tests have some shortcomings, including poor patient compliance, the ne for dietary and medication restrictions, and poor sensitivity and specificity. The guaiac-based standards also have a low positive predictive value that deductions in a substantial number of normal follow-up examinations after a positive proof result. Newer tests are based forward immunochemical detection of human family in the stool. They have better specificities and higher positive predictive values than the guaiac-based fecal hidden blood tests. Although the immunochemical-based trials have better statistics, no studies have compared the guaiac-based examples with the immunochemical-based tests. Ko and associates compared the plain of patient compliance and proof characteristics of the guaiac-based fecal hidden blood tests with the immunochemical-based fecal shrouded blood tests.

The reflection was performed in a general medicine clinic of a Veterans Affairs health plan Fecal occult blood tests were ordered if the patient had not had this standard within the past year or had not had lower gastrointestinal endoscopy within the previous five years. The health theory was divided into two clusters with similar patient and physician characteristics. An automated connected view was used to remind the cherishs to order colorectal screening. single in kind group used immunochemical-based tests, while the other collection used guaiac-based tests. Patients received instructions forward how to perform the example and were sent home with the screening kits. touchstone cards were returned, and any positive conclusions were referred automatically to each patient's primary care physician. The issues measured included completion and positivity rates, time to example completion, completion of diagnostic follow-up and positive predictive values.

Of the thought population, 2,965 patients received immunochemical-based proofs and 2,964 received guaiac-based experiments The groups had similar recur rates; 48 percent of immunochemical-based cards and 47 percent of guaiac-based cards were replyed The positivity rate for the two groups was 9 percent. In patients who had positive proof results and further colon evaluation, the proportion of any token of polyps, adenomas, adenomas greater than 1 cm and colorectal malignancies discovered were similar in as well-as; not only-but also; not only-but; not alone-but groups. A total of 21 carcinomas were discovered in the reflection groups.

The authors judge that the immunochemical-based and guaiac-based exhibitions for fecal occult blood had similar performances in detecting colorectal abnormalities. plane though the immunochemical-based test is simpler to perform, patient compliance was similar between the form into groupss Because these two tests had similar rates of patient compliance and positive predictive values, use of the more expensive immunochemical-based exhibition may not be indicated in general practice.

Ko CW et al. Fecal hidden blood testing in a general medical clinic: comparison between guaiac-based and immunochemical-based criterions Am J Med August 1 2003; 115:111-4

COPYRIGHT 2004 American Academy of Family Physicians

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