Guaiac versus immunochemical tests: Faecal occult blood test screening for colorectal cancer in a rural community

Karen Hughes, Barbara Leggett, Christopher Del Mar, John Croese, Stephen Fairley, John Masson, Joanne Aitken, Alexandra Clavarino, Monika Janda, Warren R. Stanton, Shilu Tong, Beth Newman

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Abstract

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.

Original languageEnglish
Pages (from-to)358-364
Number of pages7
JournalAustralian and New Zealand Journal of Public Health
Volume29
Issue number4
DOIs
Publication statusPublished - Aug 2005

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Guaiac
Occult Blood
Hematologic Tests
Rural Population
Colorectal Neoplasms
Colonoscopy
Public Health Professional Education
Patient Participation
Queensland
Early Detection of Cancer
General Practice
Adenoma
Neoplasms
Pathology

Cite this

Hughes, Karen ; Leggett, Barbara ; Del Mar, Christopher ; Croese, John ; Fairley, Stephen ; Masson, John ; Aitken, Joanne ; Clavarino, Alexandra ; Janda, Monika ; Stanton, Warren R. ; Tong, Shilu ; Newman, Beth. / Guaiac versus immunochemical tests : Faecal occult blood test screening for colorectal cancer in a rural community. In: Australian and New Zealand Journal of Public Health. 2005 ; Vol. 29, No. 4. pp. 358-364.
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title = "Guaiac versus immunochemical tests: Faecal occult blood test screening for colorectal cancer in a rural community",
abstract = "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.",
author = "Karen Hughes and Barbara Leggett and {Del Mar}, Christopher and John Croese and Stephen Fairley and John Masson and Joanne Aitken and Alexandra Clavarino and Monika Janda and Stanton, {Warren R.} and Shilu Tong and Beth Newman",
year = "2005",
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Hughes, K, Leggett, B, Del Mar, C, Croese, J, Fairley, S, Masson, J, Aitken, J, Clavarino, A, Janda, M, Stanton, WR, Tong, S & Newman, B 2005, 'Guaiac versus immunochemical tests: Faecal occult blood test screening for colorectal cancer in a rural community' Australian and New Zealand Journal of Public Health, vol. 29, no. 4, pp. 358-364. https://doi.org/10.1111/j.1467-842X.2005.tb00207.x

Guaiac versus immunochemical tests : Faecal occult blood test screening for colorectal cancer in a rural community. / Hughes, Karen; Leggett, Barbara; Del Mar, Christopher; Croese, John; Fairley, Stephen; Masson, John; Aitken, Joanne; Clavarino, Alexandra; Janda, Monika; Stanton, Warren R.; Tong, Shilu; Newman, Beth.

In: Australian and New Zealand Journal of Public Health, Vol. 29, No. 4, 08.2005, p. 358-364.

Research output: Contribution to journalArticleResearchpeer-review

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.

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JO - Australian and New Zealand Journal of Public Health

JF - Australian and New Zealand Journal of Public Health

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