Annual Fecal Occult Blood Testing Research Articles

Screening strategies for colorectal cancer: a systematic review of the evidence.

Colorectal cancer is the third most common cancer in Canada. It is well recognized that there are improved survival rates if the disease is treated in its early stages, and indeed this may be a preventable disease. This paper systematically reviews the effectiveness of specific screening techniques for colorectal cancer in asymptomatic individuals at normal or above average risk. MEDLINE was searched for articles published between January 1966 and January 2001 by using the MESH terms 'screening' and 'colorectal neoplasia'. The reference sections of review articles published before January 2001 were checked, and content experts were surveyed. The evidence was evaluated using the standardized methodology of the Canadian Task Force on Preventive Health Care. For individuals at normal risk, there is evidence to support the use of annual or biennial fecal occult blood testing and flexible sigmoidoscopy for asymptomatic individuals over age 50 years. The evidence regarding whether only one or both of fecal occult blood testing and sigmoidoscopy should be performed is unclear, as is the evidence regarding the use of colonoscopy as an initial screen. For individuals at above average risk, the evidence supports either genetic testing or flexible sigmoidoscopy of individuals at risk in familial adenomatous polyposis kindreds, and screening with colonoscopy of patients in kindreds with hereditary nonpolyposis colon cancer. The evidence regarding colonoscopy for individuals who have a family history of colorectal polyps or cancer but do not fit the criteria for hereditary nonpolyposis colon cancer is unclear. Development of better risk stratification for screening is a high research priority, and further research, including randomized, controlled trials, into the effectiveness and feasibility of other screening modalities is necessary.

Survey of the opinions, knowledge, and practices of gastroenterologists regarding colorectal cancer screening and use of the fecal occult blood test.

Primary care physicians and internal medicine residents have poor understanding of colorectal cancer screening and the use of fecal occult blood tests. If acceptance and implementation of colorectal cancer screening is to improve, gastroenterologists may have to take a more leading role in the education of their primary care colleagues, physicians in training, and the general public. However, before this can be recommended, it is necessary to determine how closely gastroenterologists follow currently recommended guidelines and how they use fecal occult blood tests. We mailed a two-page, structured questionnaire about colorectal cancer screening and use of fecal occult blood tests to 8000 randomly selected gastroenterologists in the United States. We received responses from 24% of the gastroenterologists. Almost all used fecal occult blood tests in the office setting, 86% on stool obtained at rectal examination. The test was frequently used for reasons other than colorectal cancer screening, and often without adequate patient instruction on dietary and medication restrictions. Of the respondents, 98% commenced screening at age < or = 50 yr, whereas 37% either continued screening into advanced age or never stopped. Annual fecal occult blood testing with flexible sigmoidoscopy every 5 yr was the screening strategy recommended by 71% of the respondents, whereas 25% recommended colonoscopy every 10 yr. However, 77% of the gastroenterologists chose colonoscopy for personal colorectal cancer screening. Gastroenterologists usually give appropriate advice on colorectal cancer screening but often misuse fecal occult blood tests. This may produce excessively high false-positive screening rates, leading to unnecessary diagnostic testing without apparent benefit.

Survey of the opinions, knowledge, and practices of gastroenterologists regarding colorectal cancer screening and use of the fecal occult blood test

OBJECTIVES: Primary care physicians and internal medicine residents have poor understanding of colorectal cancer screening and the use of fecal occult blood tests. If acceptance and implementation of colorectal cancer screening is to improve, gastroenterologists may have to take a more leading role in the education of their primary care colleagues, physicians in training, and the general public. However, before this can be recommended, it is necessary to determine how closely gastroenterologists follow currently recommended guidelines and how they use fecal occult blood tests. METHODS: We mailed a two-page, structured questionnaire about colorectal cancer screening and use of fecal occult blood tests to 8000 randomly selected gastroenterologists in the United States. RESULTS: We received responses from 24% of the gastroenterologists. Almost all used fecal occult blood tests in the office setting, 86% on stool obtained at rectal examination. The test was frequently used for reasons other than colorectal cancer screening, and often without adequate patient instruction on dietary and medication restrictions. Of the respondents, 98% commenced screening at age ≤50 yr, whereas 37% either continued screening into advanced age or never stopped. Annual fecal occult blood testing with flexible sigmoidoscopy every 5 yr was the screening strategy recommended by 71% of the respondents, whereas 25% recommended colonoscopy every 10 yr. However, 77% of the gastroenterologists chose colonoscopy for personal colorectal cancer screening. CONCLUSIONS: Gastroenterologists usually give appropriate advice on colorectal cancer screening but often misuse fecal occult blood tests. This may produce excessively high false-positive screening rates, leading to unnecessary diagnostic testing without apparent benefit.

Preventable cancers: the role of obstetrician gynecologists in colorectal cancer screening

Colorectal cancer is second only to lung cancer as a cause of cancer deaths in the United States, and is the third most common cause of cancer deaths in U.S. women. Effective screening and intervention programs exist and, if followed, could halve the number of annual deaths from this disease. Detection of early-stage disease and, more important, premalignant polyps, is possible by following the recommendations of several national societies, including the American College of Obstetricians and Gynecologists. Recommended screening consists of identification of special risk factors, annual fecal occult blood testing, and flexible sigmoidoscopy every 5 years. Alternatively, a dual-contrast barium enema every 5 to 10 years or colonoscopy every 10 years are options. This article reviews the evidence underlying current screening guidelines, highlights emerging trends in screening, and analyzes the growing need for women’s health care providers to understand and promote colorectal cancer screening as part of an optimal health maintenance program.

Cost-effectiveness of screening for colorectal cancer in the general population.

A recent expert panel recommended that persons at average risk of colorectal cancer (CRC) begin screening for CRC at age 50 years using 1 of several strategies. However, many aspects of different CRC screening strategies remain uncertain. To assess the consequences, costs, and cost-effectiveness of CRC screening in average-risk individuals. Cost-effectiveness analysis from a societal perspective using a Markov model. Hypothetical subjects representative of the 50-year-old US population at average risk for CRC. Simulated clinical practice in the United States. Discounted lifetime costs, life expectancy, and incremental cost-effectiveness (CE) ratio, compared used 22 different CRC screening strategies, including those recommended by the expert panel. In 1 base-case analysis, compliance was assumed to be 60% with the initial screen and 80% with follow-up or surveillance colonoscopy. The most effective strategy for white men was annual rehydrated fecal occult blood testing (FOBT) plus sigmoidoscopy (followed by colonoscopy if either a low- or high-risk polyp was found) every 5 years from age 50 to 85 years, which resulted in a 60% reduction in cancer incidence and an 80% reduction in CRC mortality compared with no screening, and an incremental CE ratio of $92,900 per year of life gained compared with annual unrehydrated FOBT plus sigmoidoscopy every 5 years. In a base-case analysis in which compliance with screening and follow-up is assumed to be 100%, screening more often than every 10 years was prohibitively expensive; annual rehydrated FOBT plus sigmoidoscopy every 5 years had an incremental CE ratio of $489,900 per life-year gained compared with the same strategy every 10 years. Other strategies recommended by the expert panel were either less effective or cost more per year of life gained than the alternatives. Colonoscopy every 10 years was less effective than the combination of annual FOBT plus sigmoidoscopy every 5 years. However, a single colonoscopy at age 55 years achieves nearly half of the reduction in CRC mortality obtainable with colonoscopy every 10 years. Because of increased life expectancy among white women and increased cancer mortality among blacks, CRC screening was even more cost-effective in these groups than in white men. Screening for CRC, even in the setting of imperfect compliance, significantly reduces CRC mortality at costs comparable to other cancer screening procedures. However, compliance rates significantly affect the incremental CE ratios. In this model of CRC, 60% compliance with an every 5-year schedule of screening was roughly equivalent to 100% compliance with an every 10-year schedule. Mathematical modeling used to inform clinical guidelines needs to take into account expected compliance rates. JAMA. 2000;284:1954-1961.

Colorectal cancer screening participation by older women

Objective: Although recent screening guidelines recommend annual fecal occult blood testing (FOBT) for adults aged ≥50, a number of studies report that these tests are underused. Systematic efforts to increase awareness of colorectal cancer (CRC) and to promote screening participation are needed to meet national objectives for CRC control. Methods: This study examined CRC-screening practices and evaluated factors related to recent participation in screening by FOBT in a sample of women aged 50 to 80 who were surveyed about their use of clinical preventive services at Group Health Cooperative, a managed care organization in western Washington State. Results: Of the 931 women eligible for analysis, 75% reported ever having been screened by FOBT and 48% reported having been screened within 2 years before the survey. Participation in screening did not vary by demographic characteristics or by perceived or actual risk of CRC. Women with a positive attitudes toward CRC screening had sevenfold greater odds of recent screening by FOBT (odds ratio=7.1; 95% confidence interval, 4.4 to 11.6). Only 58% of study women reported that their physicians encouraged CRC screening, but this factor was strongly related to participation (odds ratio=12.7; 95% confidence interval, 6.6 to 24.4). Conclusions: We identified several areas in which understanding of CRC risk may be low. As a whole, these findings suggest that effective strategies to control CRC may include efforts to improve knowledge of risk and prevention, but must also appeal directly to primary care physicians to identify and address their barriers to screening recommendations.

A decision model and cost-effectiveness analysis of colorectal cancer screening and surveillance guidelines for average-risk adults.

Guidelines for colorectal cancer screening and surveillance in people at average risk and at increased risk have recently been published by the American Gastroenterological Association. The guidelines for the population at average risk were evaluated using cost-effectiveness analyses. Since colorectal cancers primarily arise from precancerous adenomas, a state transition model of disease progression from adenomatous polyps was developed. Rather than assuming that polyps turn to cancer after a fixed interval (dwell time), such transitions were modeled to occur as an exponential function of the age of the polyps. Screening strategies included periodic fecal occult blood test, flexible sigmoidoscopy, double-contrast barium enema, and colonoscopy. Screening costs in 1994 dollars were estimated using Medicare and private claims data, and clinical parameters were based upon published studies. Cost per life-year saved was $12,636 for flexible sigmoidoscopy every 5 years and $14,394 for annual fecal occult blood testing. The assumption made for polyp dwell time critically affected the attractiveness of alternative screening strategies. Sigmoidoscopy every 5 years and annual fecal blood testing were the two most cost-effective strategies, but with low compliance, occult blood testing was less cost-effective. Lowering colonoscopy costs greatly improved the cost-effectiveness of colonoscopy every 10 years.

Organizational systems used by California capitated medical groups and independent practice associations to increase cancer screening

Patients in health maintenance organizations (HMOs) appear to have higher utilization of cancer screening tests than patients with fee-for-service insurance. The authors surveyed the medical directors of 174 physician organizations in a California network model HMO to obtain information regarding their organizational structure, implementation of guidelines, and use of systems to increase cancer screening. The majority of independent practice associations (IPAs) and medical groups (IMGs) in this California HMO had guidelines and office systems aimed at improving cancer screening. These activities were reported more frequently for mammography and Papanicolaou (Pap) smears than for colorectal carcinoma screening. IMGs reported using flow sheets more often than IPAs. Chart audits were performed more frequently for mammography (48% for IMGs and 40% for IPAs) and Pap smears (45% and 40%, respectively) than for colorectal carcinoma screening (38% and 30%, respectively). Approximately 50% of IPAs and IMGs reported mailing reminders to patients for mammography and Pap smears, but only a few did so for colorectal carcinoma screening. Annual fecal occult blood testing was believed by most medical directors to be a reasonable strategy for managed care patients (86% of IPAs and 96% of IMGs); however, fewer believed that screening sigmoidoscopy for patients ages 50-70 years was a reasonable expectation (71% and 78%, respectively). The majority of IPAs and IMGs in this California HMO reported using both guidelines and office systems to improve cancer screening rates. Further research is needed to understand the effect of these systems, as well their complex interactions with competing incentives, on cancer screening in managed care patients.

Organizational systems used by California capitated medical groups and independent practice associations to increase cancer screening

BACKGROUND Patients in health maintenance organizations (HMOs) appear to have higher utilization of cancer screening tests than patients with fee-for-service insurance. METHODS The authors surveyed the medical directors of 174 physician organizations in a California network model HMO to obtain information regarding their organizational structure, implementation of guidelines, and use of systems to increase cancer screening. RESULTS The majority of independent practice associations (IPAs) and medical groups (IMGs) in this California HMO had guidelines and office systems aimed at improving cancer screening. These activities were reported more frequently for mammography and Papanicolaou (Pap) smears than for colorectal carcinoma screening. IMGs reported using flow sheets more often than IPAs. Chart audits were performed more frequently for mammography (48% for IMGs and 40% for IPAs) and Pap smears (45% and 40%, respectively) than for colorectal carcinoma screening (38% and 30%, respectively). Approximately 50% of IPAs and IMGs reported mailing reminders to patients for mammography and Pap smears, but only a few did so for colorectal carcinoma screening. Annual fecal occult blood testing was believed by most medical directors to be a reasonable strategy for managed care patients (86% of IPAs and 96% of IMGs); however, fewer believed that screening sigmoidoscopy for patients ages 50–70 years was a reasonable expectation (71% and 78%, respectively). CONCLUSIONS The majority of IPAs and IMGs in this California HMO reported using both guidelines and office systems to improve cancer screening rates. Further research is needed to understand the effect of these systems, as well their complex interactions with competing incentives, on cancer screening in managed care patients. Cancer 2000;88:2824–31. © 2000 American Cancer Society.

Colorectal cancer screening in Italy: feasibility and cost-effectiveness in a model area.

To evaluate the feasibility and cost-effectiveness of screening programmes for colorectal cancer in Italy. DESIGN; We compared five types of programmes: annual faecal occult blood testing, sigmoidoscopy (every 5 years), faecal occult blood testing plus sigmoidoscopy (every 1 and 5 years), colonoscopy (every 10 years) (all in the age group 55-69 years, last examination at 70 years) and 'filter' colonoscopy. The latter had to be performed in persons at 50 years of age and repeated every 10 years until the age of 70. Costs for the tests and colon cancer care were paid by the Regional Health Office to the hospitals performing the procedures/treatments. Data were applied to a small model area in northern Italy (Gemona, 80,000 inhabitants) with well-known demographic (age distribution) and epidemiological (colon cancer incidence) features. All-inclusive 10-year costs per screenee and per death prevented (in US dollars) were: 965 and 77,200 for faecal occult blood testing; 436 and 15,500 for sigmoidoscopy; 1521 and 35,000 for sigmoidoscopy plus faecal occult blood testing; 510 and 15,100 for colonoscopy; 510 and 14,000 for 'filter' colonoscopy. With 'filter' colonoscopy the programme required 870 colonoscopies per year, while with colonoscopy 13,700 colonoscopies were needed at time zero. In Italy, screening programmes based on sigmoidoscopy/colonoscopy are more cost effective than those based on faecal occult blood testing. 'Filter' colonoscopy at age 50 appears superior to the other types of endoscopy-based screening programmes because it utilizes, at any point in time, a much smaller fraction of available resources.

Reducing colorectal cancer mortality by repeated faecal occult blood test: a nested case–control study

Randomised trials have shown the efficacy of faecal occult blood testing (FOBT) in reducing colorectal cancer mortality, but observational studies are needed to monitor such efficacy in population programmes. We conducted a nested case–control study on a cohort of 21 879 subjects who participated in a colorectal screening programme from 1978 to 1995, undergoing at least one FOBT test. 95 fatal cases of colorectal cancer were eligible for the study. For each fatal case, 5 non-fatal matched controls were randomly selected from the cohort. FOBT screening history was less common among cases than controls. The odds ratio of colorectal cancer mortality among ‘attenders’ (defined as those who underwent a second FOBT within 2 years of study entry) with respect to ‘non-attenders’ was 0.64 (95% confidence interval 0.36–1.15). We also computed odds ratios defining exposure as one or more tests in the detectable preclinical period, hypothesising various lengths for the latter, which, however, yielded an efficacy estimate biased towards the null. A strong inverse relationship was observed between mortality and the number of tests, but this phenomenon is interpretable as ‘healthy screenee bias’. The results suggest that the potential efficacy in preventing colorectal cancer mortality through annual FOBT screening may be of the order of one third.

Screening for Colorectal Cancer— United States, 1997

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. During 1999, approximately 129,400 new cases of colorectal cancer will be diagnosed, and 56,600 persons will die from the disease. In 1996, the U.S. Preventive Services Task Force (USPSTF) recommended the use of specific screening tests (i.e., annual fecal-occult blood testing [FOBT] and/or periodic flexible sigmoidoscopy for persons aged > or =50 years) to reduce colorectal cancer-related mortality. In 1997, the American Cancer Society and an interdisciplinary task force developed guidelines that recommend one test or a combination of several tests for colorectal cancer screening. To estimate the proportion of the U.S. population that received colorectal cancer screening tests, CDC analyzed data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) on the use of a home-administered blood stool test, or FOBT, and sigmoidoscopy/proctoscopy. This report summarizes the results of this analysis, which documents low rates of use of colorectal cancer screening tests.

Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood.

In 1993, a randomized controlled trial in Minnesota showed, after 13 years of follow-up, that annual fecal occult blood testing was effective in reducing colorectal cancer mortality by at least 33%. Biennial screening (i.e., every 2 years) resulted in only a 6% mortality reduction. Two European trials (in England and in Denmark) subsequently showed statistically significant 15% and 18% mortality reductions with biennial screening. Herein, we provide updated results-through 18 years of follow-up--from the Minnesota trial that address the apparent inconsistent findings among the trials regarding biennial screening. From 1976 through 1977, a total of 46551 study subjects, aged 50-80 years, were recruited and randomly assigned to an annual screen, a biennial screen, or a control group. A screen consisted of six guaiac-impregnated fecal occult blood tests (Hemoccult) prepared in pairs from each of three consecutive fecal samples. Participants with at least one of the six tests that were positive were invited for a diagnostic examination that included colonoscopy. All participants were followed annually to ascertain incident colorectal cancers and deaths. The numbers of deaths from all causes were similar among the three study groups. Cumulative 18-year colorectal cancer mortality was 33% lower in the annual group than in the control group (rate ratio, 0.67; 95% confidence interval [CI] = 0.51-0.83). The biennial group had a 21% lower colorectal cancer mortality rate than the control group (rate ratio, 0.79; 95% CI = 0.62-0.97). A marked reduction was also noted in the incidence of Dukes' stage D cancers in both screened groups in comparison with the control group. The results from this study, together with the other two published randomized trials of fecal occult blood screening, are consistent in demonstrating a substantial, statistically significant reduction in colorectal cancer mortality from biennial screening.

COLORECTAL CANCER SCREENING

Colorectal cancer is the second most lethal cancer in the United States. The lifetime risk of developing colorectal cancer in the United States is 5%. Early detection decreases mortality, and involves stratifying individuals by risk factors. Clinicians can use several methods for detection and surveillance of colorectal cancer including the digital rectal exam (DRE), fecal occult-blood test (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema. Several groups offer guidelines recommending specific screening techniques and intervals. In general, a combination of an annual FOBT and a flexible sigmoidoscopy every 5 years is recommended for average-risk individuals. Colonoscopy is the gold standard for visualizing the entire colon, and is reserved for abnormal findings on FOBT or flexible sigmoidoscopy or for individuals of greater-than-average risk for colorectal cancer.

Colorectal cancer screening.

Comprehensive evidence-based guidelines for screening and surveillance for colorectal cancer were published in 1997. Backed by compelling scientific data from recently completed controlled trials and case-control studies, these guidelines recommend annual fecal occult blood test screening plus periodic flexible sigmoidoscopy about every 5 years for asymptomatic, average-risk individuals over 50 years of age. Other screening studies published during the past year refine knowledge about how these screening tests detect early cancer and polyps and assess factors that influence compliance with screening recommendations. Preliminary reports suggest revolutionary new methods of screening that may become clinically feasible in the next millennium.

PIC3 Colorectal Cancer Screening: Cost-Effectiveness Analysis from An Italian Viewpoint

Several models of colorectal cancer (CRC) screening cost-effectiveness have been published. Most of them are based on US costs of parameters/tests used. OBJECTIVE: The purpose of this analysis was to provide a model to compare several screening programs using cost data related on Italian reimbursement system, both for ambulatorial and for hospital services. METHODS: Four screening programs were assessed in comparison with nonscreening: annual fecal occult blood test alone (FOBT), flexible sigmoidoscopy every five years (FS), FOBT and FS combined, and one-time colonoscopy (CO). The analysis was carried out by considering a 10-year screening period. Effectiveness data were derived from recent literature; cost-effectiveness was defined as “cost per cancer prevented” (CCP) and “cost per cancer death prevented” (CCDP). Computer analysis was performed using algebraic formula. Data robustness was tested with sensitivity analysis of main variables: patient compliance, cost of cancer care, and cost of CO complication. Maximization analysis was carried out on a risk population (selected screening). RESULTS: CO had the greatest impact on CRC mortality, followed by FS+FOBT, FS, and FOBT. CO also resulted in the most cost-effective program, both for CCP and for CCDP, followed by FOBT+FS, FS, and FOBT for all the compliance levels considered. Sensitivity analysis reinforced these results. Maximization analysis amplified both efficacy and cost-effectiveness of CO as a test for selected screening. CONCLUSION: This model, even with the limitation linked to cost assumption problems, seems to be useful for authorities that will organize general population CRC screening programs.

DEVELOPMENTS IN CANCER SCREENING

This past year saw several noteworthy developments in cancer screening: The benefit of fecal occult blood testing (FOBT) for colorectal cancer was confirmed, the optimal intervals for prostate-specific antigen (PSA) testing were addressed, and Pap testing after hysterectomy was discouraged. Ever since a 1993 randomized trial from Minnesota showed that annual FOBT reduced mortality from colorectal cancer by 33%, corroboration of these results has been eagerly awaited ( N Engl J Med 1993 May 13; 328:1365). This year, two European trials added to the evidence supporting FOBT ( Lancet 1996 Nov 30; 348:1467, 1472). The first randomized about 62,000 people aged …

Fecal occult blood screening in the Minnesota study: role of chance detection of lesions.

In the Minnesota Colon Cancer Control Study, annual fecal occult blood testing reduced mortality from colorectal cancer by at least 33.4%. Some attribute a large part of this reduction to chance detection of cancers by colonoscopies; rehydration of guaiac test slides greatly increased positivity and consequently the number of colonoscopies performed. This study was conducted to determine how much of the reduction resulted from chance detection. We used a mathematical model developed by Lang and Ransohoff to estimate the proportion of the 33.4% mortality attainable by chance alone. Applying the model requires the specification of five parameters: duration of follow-up, rate of compliance with fecal occult blood testing, rate of compliance with colonoscopy, positivity rate, and efficacy of colonoscopy in reducing colorectal cancer mortality. We took values for four of the five parameters directly from the Minnesota study. For the fifth parameter, efficacy of colonoscopy, we selected a value of 60%, based on the conclusions of another study. Whereas the Lang-Ransohoff model selects persons for colonoscopy by chance alone, those with bleeding cancers would also be selected by sensitive fecal occult blood testing. We therefore adjusted the result of the Lang-Ransohoff model for this dual detectability. We found that 16%-25% of the reduction in colorectal cancer deaths effected by fecal occult blood testing in the Minnesota study was due to chance detection; the remainder was due to sensitive detection. Chance played a minor role in the detection of colorectal cancers by fecal occult blood testing in the Minnesota study.

Analysis of Colorectal Cancer Stage Among HMO Members Targeted for Screening

This study is a retrospective analysis of data collected from patient medical records, a fecal occult blood test (FOBT) screening program, and computerized health maintenance organization (HMO) claims and encounters records. To identify factors associated with a diagnosis of early (Dukes A and B) colorectal cancer among older adults targeted for annual FOBT screening. Study subjects were insured by the former US Healthcare Inc (Blue Bell, Pa), an independent practice association-type HMO. The HMO was recently integrated into Aetna-US Healthcare. Before diagnosis, subjects were eligible for free annual FOBT screening through the HMO's colorectal cancer screening program. The study subjects included men and women (N = 222) who were aged 50 years or older and had a diagnosis of colorectal cancer between 1987 and 1990. Variables considered were patient age, gender, socioeconomic status, medical history, screening history, length of enrollment in the HMO, and stage of disease at diagnosis. Univariate analyses indicate that colorectal cancer diagnosis due to FOBT screening (P = .03), frequency of FOBT screening (P = .09), and length of HMO membership (P = .10) were positively related to being diagnosed as having early stage colorectal cancer. Multivariable analysis shows that having a screen-detected colorectal cancer was significantly and positively related (P = .03) to being diagnosed as having early stage disease. Findings support annual FOBT screening among older adults. Results illustrate the value of applying standard methods to the collection and analysis of patient data in a managed care context. The study also highlights a need for research on patient adherence to screening and physician follow-up of abnormal screening test results.

These gastroenterologists say YES!

While methods of screening for colorectal cancer undoubtedly will be refined and new techniques developed, there is ample evidence to support use of the currently employed protocol: annual fecal occult blood testing and periodic flexible sigmoidoscopy. Aggressive attempts to educate physicians and patients on the importance of such screening are needed. Primary care physicians can play an important role in ensuring patient compliance and reducing the incidence of this serious public health problem.