Abstract
The only established objectives of screening asympomatic people for occult stool blood are to detect curable olorectal cancer and to prevent colorectal cancer (CRC) y detecting and resecting premalignant polyps [1]. Colrectal cancer and polyps are suitable targets for faecal ccult blood test (FOBT) screening because they are comon and lethal, and they usually have a long pre-clinical hase during which they are easily detectable and curable 2]. Most large colorectal polyps and early cancers shed mall amounts of blood into the colonic lumen continuously r intermittently. Randomized controlled trials proved that nnual FOBT screening followed by colonoscopy for those ith positive screens substantially reduces both the morality and incidence of colorectal cancer [3,4]. In addition, OBT screening for colorectal neoplasia has been shown to e highly cost-effective, costing less than $15,000 per year of ife saved which is appreciably more cost-effective than many urrently-accepted preventive medical interventions [5]. In contrast, gastric cancer is now much less common in estern countries and it has no well-defined pre-clinical hase during which curable cancer can reliably be detected by creening. No method of screening for gastric cancer has been hown to be effective or cost-effective in Western countries. hen gastric cancers are diagnosed because they have caused astrointestinal (GI) bleeding or abdominal symptoms, most re advanced and incurable. The Minnesota FOBT Trial showed that a program of nnual screening of asymptomatic individuals over the age f 50 years using a sensitive FOBT will detect over 90% of ll colorectal cancers [6]. Specificity of screening, however, s relatively low—there are many “false-positive” screens here complete colonoscopy reveals no neoplasia. Since
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