TY - JOUR
T1 - Guaiac versus immunochemical tests
T2 - Faecal occult blood test screening for colorectal cancer in a rural community
AU - Hughes, Karen
AU - Leggett, Barbara
AU - Del Mar, Christopher
AU - Croese, John
AU - Fairley, Stephen
AU - Masson, John
AU - Aitken, Joanne
AU - Clavarino, Alexandra
AU - Janda, Monika
AU - Stanton, Warren R.
AU - Tong, Shilu
AU - Newman, Beth
PY - 2005/8
Y1 - 2005/8
N2 - 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-II) 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% CI 1.6-2.2). Women were more likely to comply with testing than men (OR=1.4, 95% CI 1.2-1.7), and people in their 60s were less likely to participate than those 70-74 years (OR=0.8, 95% CI 0.6-0.9). The positivity rate was higher for the immunochemical (9.5%) than the guaiac (3.9%) test (χ2=9.2, p=0.002), with positive predictive values for cancer or adenoma of advanced pathology of 37.8% (95% CI 28.1-48.6) for !nform and 40.0% (95% CI 16.8-68.7) for Hemoccult-II. 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.
AB - 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-II) 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% CI 1.6-2.2). Women were more likely to comply with testing than men (OR=1.4, 95% CI 1.2-1.7), and people in their 60s were less likely to participate than those 70-74 years (OR=0.8, 95% CI 0.6-0.9). The positivity rate was higher for the immunochemical (9.5%) than the guaiac (3.9%) test (χ2=9.2, p=0.002), with positive predictive values for cancer or adenoma of advanced pathology of 37.8% (95% CI 28.1-48.6) for !nform and 40.0% (95% CI 16.8-68.7) for Hemoccult-II. 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.
UR - http://www.scopus.com/inward/record.url?scp=27944446064&partnerID=8YFLogxK
U2 - 10.1111/j.1467-842X.2005.tb00207.x
DO - 10.1111/j.1467-842X.2005.tb00207.x
M3 - Article
C2 - 16222934
AN - SCOPUS:27944446064
SN - 1326-0200
VL - 29
SP - 358
EP - 364
JO - Australian and New Zealand Journal of Public Health
JF - Australian and New Zealand Journal of Public Health
IS - 4
ER -
