Open AccessGuaiac versus immunochemical tests: faecal occult blood test screening for colorectal cancer in a rural community
Author(s) -
Hughes Karen,
Leggett Barbara,
Mar Christopher Del,
Croese John,
Fairley Stephen,
Masson John,
Aitkne Joanne,
Clavarino Alexandra,
Janda Monika,
Stanton Warren R.,
Tong Shilu,
Newman Beth
Publication year - 2005
Publication title -
australian and new zealand journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.946
H-Index - 76
eISSN - 1753-6405
pISSN - 1326-0200
DOI - 10.1111/j.1467-842x.2005.tb00207.x
Subject(s) - medicine , colorectal cancer , colonoscopy , occult , gastroenterology , adenoma , colorectal cancer screening , cancer , population , test (biology) , pathology , environmental health , alternative medicine , paleontology , biology
Objective: To describe patient participation and clinical performance in a colorectal cancer (CRC) screening program utilising faecal occult blood test (FOBT). Methods: A community‐based intervention was conducted in a small, rural community in north Queensland, 2000/01. One of two FOBT kits – guaiac (Hemoccult‐ll) or immunochemical (Inform) – was assigned by general practice and mailed to participants (3,358 patients aged 50–74 years listed with the local practices). Results: Overall participation in FOBT screening was 36.3%. Participation was higher with the immunochemical kit than the guaiac kit (OR=1.9, 95% Cl 1.6‐2.2). Women were more likely to comply with testing than men (OR=1.4, 95% Cl 1.2‐1.7), and people in their 60s were less likely to participate than those 70–74 years (OR=0.8, 95% Cl 0.6‐0.9). The positivity rate was higher for the immunochemical (9.5%) than the guaiac (3.9%) test (χ 2 =9.2, p =0.002), with positive predictive values for cancer or adenoma of advanced pathology of 37.8% (95% Cl 28.1–48.6) for !nform and 40.0% (95% Cl 16.8–68.7) for Hemoccult‐ll. Colonoscopy follow‐up was 94.8% with a medical complication rate of 2–3%. Conclusions: An immunochemical FOBT enhanced participation. Higher positivity rates for this kit did not translate into higher false‐positive rates, and both test types resulted in a high yield of neoplasia. Implications: In addition to type of FOBT, the ultimate success of a population‐based screening program for CRC using FOBT will depend on appropriate education of health professionals and the public as well as significant investment in medical infrastructure for colonoscopy follow‐up.