Comparison of coloscreen self-test® and Haemoccult® faecal occult blood tests in the detection of colorectal cancer in symptomatic patients

Pye, Geoffrey W.; Jackson, J. P.; Thomas, W. M.; Hardcastle, J. D.

doi:10.1002/bjs.1800770612

Cited by 17 publications

(9 citation statements)

References 3 publications

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“…This is within the range of 50-86% quoted in the NHSME CRC Needs Assessment Review (2), and corresponds most closely with the levels of 54% and 58% reported in 1990 and 1992 for non-rehydrated guaiac tests in preliminary results from the Nottingham trial (21,22). Rehydration of guaiac FOBT slides only yields greater sensitivity at the price of lower specificity, ie higher false-positivity rates.…”

Section: Sensitivity Of Fortsupporting

confidence: 82%

Options for Screening for Colorectal Cancer in the Royal Air Force: A Cost-effectiveness Evaluation

Daniels¹,

McKee

1995

J R Army Med Corps

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SUMMARY:-Colorectal cancer (CRC) is the second most common form of malignancy, causing death after late presentation in two-thirds of cases. Early detection makes curative treatment likely. Faecal occult blood tests (FOBTs) detect some pre-symptomatic CRCs and their precursor lesions, adenomatous polyps. A trial showed reduced mortality in USA volunteers aged 50-80 with regular FOBTs; both this and the Nottingham populationbased trial detected earlier-stage CRCs.Current US guidelines recommend annual digital rectal examination and FOBTs from age 40. FOBTs have been included in the USAF examination of aircrew for several years. Day-case colonoscopy, with appropriate biopsyexcision, is the first-choice follow-up investigation. This study aims to investigate the design of any programme to introduce FOBTs as part of the RAF's existing schedule of Periodic Medical Examinations (PMEs) and Screenings, and the age groups to be included, rather than the decision as to whether or not it should be commenced. The analysis therefore examines the cost per cancer detected. The information required to evaluate subsequent outcomes, such as cost per life-year saved, is not available for the RAF population so speculative extrapolation from other data is not attempted.Over a third of RAF personnel are under the age of 25, nearly three-quarters under 35 and over four-fifths under 40. Over a quarter of the 4 RAF CRC cases pa occur under age 40 and two-thirds under 50. The most costeffective age at which to introduce FOBTs in the RAF is 40, regardless of the following parameters.Assuming FOBT sensitivity of 55% and positivity 5%, FOBT costing 23p and colonoscopy £175, starting FOBTs RAF-wide at age 40 would cost annually £35,968 and £15,881 per CRC case detected. The FOBT contribution to the costs is extremely small and the importance of maximising sensitivity and specificity very great. Hence dietary modification, and using a test or combination of tests with higher sensitivity and/or lower false-positivity, even if much more expensive, would be highly cost-effective, reducing the above costs substantially. Counting as "cases" persons with adenomas reduces the cost per "case" detected by about 75%.A pilot study is proposed concerning the introduction on selected stations of FOBTs with RAF PMEs/Screenings, from age 40, to determine: sensitivity and false-positivity rates for single and serial FOBTs, and the predictive value of positive tests, in RAF screenees; the annual cost; the costs per CRC case, and per CRC-plus-adenoma case, detected; possibly, an estimate of the cost per life-year saved; and, hence, whether the programme should be extended to all RAF personnel.FOB screening from age 40 would miss the quarter of RAF CRC cases which occur in personnel under 40. Identification is therefore recommended now of personnel at high risk for CRC, because of personal or family history, at all PMEs/Screenings, regardless of age, with the subsequent offer of serial FOBTs annually and regular colonoscopy. Two half-yearly FOBTs, done with PME...

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Section: Sensitivity Of Fortsupporting

confidence: 82%

Options for Screening for Colorectal Cancer in the Royal Air Force: A Cost-effectiveness Evaluation

Daniels¹,

McKee

1995

J R Army Med Corps

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“…A total of 421 full papers were retrieved, of which 38 were finally considered relevant for the review 1112 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 Reference checking yielded 11 additional relevant papers 863 64 65 66 67 68 69 70 71 72 As four papers8 29 30 72 presented information on two studies, our total number of primary diagnostic studies for inclusion was 47.…”

Section: Resultsmentioning

confidence: 99%

“…66 67 68 Of the 33 studies in secondary care, 20 were performed in diagnostic clinics (colonoscopy,8 27 32 36 37 39 41 43 45 46 50 51 52 53 55 71 double contrast barium enema54 57 62 64) and 13 in outpatient clinics 1112 29 35 38 42 47 48 56 58 59 60 69 Prevalence of colorectal cancer ranged from 0.4% to 15%.…”

Section: Resultsmentioning

confidence: 99%

Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis

Jellema

Windt

Bruinvels

et al. 2010

BMJ

177

154

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Objective To summarise available evidence on diagnostic tests that might help primary care physicians to identify patients with an increased risk for colorectal cancer among those consulting for non-acute lower abdominal symptoms. Data sources PubMed, Embase, and reference screening. Study eligibility criteria Studies were selected if the design was a diagnostic study; the patients were adults consulting because of non-acute lower abdominal symptoms; tests included signs, symptoms, blood tests, or faecal tests. Study appraisal and synthesis methods Two reviewers independently assessed quality with a modified version of the QUADAS tool and extracted data. We present diagnostic two by two tables and pooled estimates of sensitivity and specificity. We refrained from pooling when there was considerable clinical or statistical heterogeneity. Results 47 primary diagnostic studies were included. Sensitivity was consistently high for age ≥50 (range 0.81-0.96, median 0.91), a referral guideline (0.80-0.94, 0.92), and immunochemical faeces tests (0.70-1.00, 0.95). Of these, only specificity of the faeces tests was good. Specificity was consistently high for family history (0.75-0.98, 0.91), weight loss (0.72-0.96, 0.89), and iron deficiency anaemia (0.83-0.95, 0.92), but all tests lacked sensitivity. None of these six tests was (sufficiently) studied in primary care. Conclusions Although combinations of symptom and results of immunochemical faeces tests showed good diagnostic performance for colorectal cancer, evidence from primary care is lacking. High quality studies on their role in the diagnostic investigation of colorectal cancer in primary care are urgently needed. INTRODUCTIONColorectal cancer is the second most common cancer in Europe.1 2 The five year survival rate for early stage colorectal cancer is greater than 90%, whereas the five year survival rate for those diagnosed with widespread

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“…In this study, Coloscreen Self-Test was also less sensitive. 16 Immunological tests also exist. One, Hemeselect, was compared with Haemoccult, in a population with gastrointestinal symptoms on three consecutive daily bowel motions.…”

Section: N Intestinal Obstructionmentioning

confidence: 99%

Best practice in primary care pathology: review 8

Smellie

Hampton

Bowlees³

et al. 2006

J Clin Pathol

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This eighth best practice review examines four series of common primary care questions in laboratory medicine: (i) sodium abnormalities; (ii) faecal occult blood testing; (iii) warfarin management; and (iv) sputum cytology in diagnosis of bronchopulmonary malignancy. The review is presented in question-answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

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Comparison of coloscreen self-test® and Haemoccult® faecal occult blood tests in the detection of colorectal cancer in symptomatic patients

Cited by 17 publications

References 3 publications

Options for Screening for Colorectal Cancer in the Royal Air Force: A Cost-effectiveness Evaluation

Options for Screening for Colorectal Cancer in the Royal Air Force: A Cost-effectiveness Evaluation

Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis

Best practice in primary care pathology: review 8

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