Colon cancer screening. The dilemma of positive screening tests

Performance Characteristics and Comparison of Two Fecal Occult Blood Tests in Patients Undergoing Colonoscopy

“…However, there was no statistical significant difference in the overall diagnostic accuracy of the EZ and HO tests when evaluating adenomas in both the complete cohort and the screening cohort. Our results are similar to those of previous FOBT studies reporting sensitivities for adenomas in the range of 13% to [7,8]. Previous studies have shown that the sensitivity of FOBT is very low in patients who only have adenomas [13,14].…”

“…Despite the widespread use of FOBT in colorectal cancer screening, concerns remain regarding its sensitivity and specificity [7][8][9]. In fact, the sensitivity of the Hemoccult II (HO) test (Beckman Coulter; formerly SmithKline Diagnostics) has been reported to be as low as 26% for cancers and 13% for large adenomas [10].…”

Relative Frequency of Upper Gastrointestinal and Colonic Lesions in Patients with Positive Fecal Occult-Blood Tests

“…Thirty patients with lesions in the upper gastrointestinal tract were long-term users of aspirin, ethanol, nonsteroidal antiinflammatory drugs, or a combination of these substances. The most common colonic lesions were adenomas more than 1.0 cm in diameter (29 patients), carcinoma (13), colitis (5), and vascular ectasia (5). Although the overall sensitivity of symptoms for the detection of gastrointestinal lesions was low, logistic-regression analysis demonstrated that the presence of symptoms in the upper gastrointestinal tract was associated with the detection of lesions in the upper gastrointestinal tract (odds ratio, 2.6; 95 percent confidence interval, 1.4 to 4.7).…”

The Findings and Impact of Nonrehydrated Guaiac Examination of the Rectum (FINGER) Study

“…7 Although widely practiced, this screening method has been discouraged because it is thought to increase the number of false-positive FOBT results. 8,9 In clinical practice, asymptomatic individuals with a positive FOBT result obtained by DRE are often referred for a colonoscopic evaluation. 10 To date, there are almost no data on the diagnostic yield of colonoscopy in asymptomatic patients with a positive FOBT result obtained by DRE.…”