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Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population.
Gastroenterology. 2008 Jul; 135(1):82-90.G

Abstract

BACKGROUND & AIMS

Despite poor performance, guaiac-based fecal occult blood tests (G-FOBT) are most frequently implemented for colorectal cancer screening. Immunochemical fecal occult blood tests (I-FOBT) are claimed to perform better, without randomized comparison in screening populations. Our aim was to randomly compare G-FOBT with I-FOBT in a screening population.

METHODS

We conducted a population-based study on a random sample of 20,623 individuals 50-75 years of age, randomized to either G-FOBT (Hemoccult-II) or I-FOBT (OC-Sensor). Tests and invitations were sent together. For I-FOBT, the standard cutoff of 100 ng/ml was used. Positive FOBTs were verified with colonoscopy. Advanced adenomas were defined as >or=10 mm, high-grade dysplasia, or >or=20% villous component.

RESULTS

There were 10,993 tests returned: 4836 (46.9%) G-FOBTs and 6157 (59.6%) I-FOBTs. The participation rate difference was 12.7% (P < .01). Of G-FOBTs, 117 (2.4%) were positive versus 339 (5.5%) of I-FOBTs. The positivity rate difference was 3.1% (P < .01). Cancer and advanced adenomas were found, respectively, in 11 and 48 of G-FOBTs and in 24 and 121 of I-FOBTs. Differences in positive predictive value for cancer and advanced adenomas and cancer were, respectively, 2.1% (P = .4) and -3.6% (P = .5). Differences in specificities favor G-FOBT and were, respectively, 2.3% (P < .01) and -1.3% (P < .01). Differences in intention-to-screen detection rates favor I-FOBT and were, respectively, 0.1% (P < .05) and 0.9% (P < .01).

CONCLUSIONS

The number-to-scope to find 1 cancer was comparable between the tests. However, participation and detection rates for advanced adenomas and cancer were significantly higher for I-FOBT. G-FOBT significantly underestimates the prevalence of advanced adenomas and cancer in the screening population compared with I-FOBT.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. l.vanrossum@mdl.umcn.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18482589

Citation

van Rossum, Leo G., et al. "Random Comparison of Guaiac and Immunochemical Fecal Occult Blood Tests for Colorectal Cancer in a Screening Population." Gastroenterology, vol. 135, no. 1, 2008, pp. 82-90.
van Rossum LG, van Rijn AF, Laheij RJ, et al. Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology. 2008;135(1):82-90.
van Rossum, L. G., van Rijn, A. F., Laheij, R. J., van Oijen, M. G., Fockens, P., van Krieken, H. H., Verbeek, A. L., Jansen, J. B., & Dekker, E. (2008). Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology, 135(1), 82-90. https://doi.org/10.1053/j.gastro.2008.03.040
van Rossum LG, et al. Random Comparison of Guaiac and Immunochemical Fecal Occult Blood Tests for Colorectal Cancer in a Screening Population. Gastroenterology. 2008;135(1):82-90. PubMed PMID: 18482589.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. AU - van Rossum,Leo G, AU - van Rijn,Anne F, AU - Laheij,Robert J, AU - van Oijen,Martijn G, AU - Fockens,Paul, AU - van Krieken,Han H, AU - Verbeek,Andre L, AU - Jansen,Jan B, AU - Dekker,Evelien, Y1 - 2008/03/25/ PY - 2007/10/25/received PY - 2008/03/10/revised PY - 2008/03/20/accepted PY - 2008/5/17/pubmed PY - 2008/8/9/medline PY - 2008/5/17/entrez SP - 82 EP - 90 JF - Gastroenterology JO - Gastroenterology VL - 135 IS - 1 N2 - BACKGROUND & AIMS: Despite poor performance, guaiac-based fecal occult blood tests (G-FOBT) are most frequently implemented for colorectal cancer screening. Immunochemical fecal occult blood tests (I-FOBT) are claimed to perform better, without randomized comparison in screening populations. Our aim was to randomly compare G-FOBT with I-FOBT in a screening population. METHODS: We conducted a population-based study on a random sample of 20,623 individuals 50-75 years of age, randomized to either G-FOBT (Hemoccult-II) or I-FOBT (OC-Sensor). Tests and invitations were sent together. For I-FOBT, the standard cutoff of 100 ng/ml was used. Positive FOBTs were verified with colonoscopy. Advanced adenomas were defined as >or=10 mm, high-grade dysplasia, or >or=20% villous component. RESULTS: There were 10,993 tests returned: 4836 (46.9%) G-FOBTs and 6157 (59.6%) I-FOBTs. The participation rate difference was 12.7% (P < .01). Of G-FOBTs, 117 (2.4%) were positive versus 339 (5.5%) of I-FOBTs. The positivity rate difference was 3.1% (P < .01). Cancer and advanced adenomas were found, respectively, in 11 and 48 of G-FOBTs and in 24 and 121 of I-FOBTs. Differences in positive predictive value for cancer and advanced adenomas and cancer were, respectively, 2.1% (P = .4) and -3.6% (P = .5). Differences in specificities favor G-FOBT and were, respectively, 2.3% (P < .01) and -1.3% (P < .01). Differences in intention-to-screen detection rates favor I-FOBT and were, respectively, 0.1% (P < .05) and 0.9% (P < .01). CONCLUSIONS: The number-to-scope to find 1 cancer was comparable between the tests. However, participation and detection rates for advanced adenomas and cancer were significantly higher for I-FOBT. G-FOBT significantly underestimates the prevalence of advanced adenomas and cancer in the screening population compared with I-FOBT. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/18482589/Random_comparison_of_guaiac_and_immunochemical_fecal_occult_blood_tests_for_colorectal_cancer_in_a_screening_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(08)00478-2 DB - PRIME DP - Unbound Medicine ER -