From Guaiac to Immune Fecal Occult Blood Tests

Abstract

Colorectal cancer is the second leading cause of cancer deaths in the United States for both men and women. Colorectal cancer screening is an important means for reducing morbidity and mortality. The American Cancer Society recommends five different screening regimens for adults of average risk, age 50 years and older. The optimal effectiveness of a screening program is dependent on the accuracy of the screening test used. An accurate screening test would have high sensitivity (positive) when an adenomatous polyp or cancer is present and high specificity (negative) in their absence. In April 2002, the American Cancer Society Colorectal Cancer Advisory Group concluded that the immunochemical fecal occult blood test has some advantages that merit revision of their guideline statement for fecal occult blood testing, to include the immunochemical fecal occult blood test. The advantages cited were the possibility of improved sensitivity and specificity and the lack of required dietary restrictions, which make it a more patient-friendly test. Several types of immunochemical fecal occult blood tests are discussed in this article, including their advantages and disadvantages compared with those of the traditional guaiac fecal occult blood testing.

Fecal-Based Colorectal Cancer Screening Among the Uninsured in Northern Manhattan

“…These findings can be partially explained by the fact that FIT requires less fecal manipulation, fewer test samples, no dietary restrictions, is generally more preferable to patients, 7,33,34 and is promoted by one-on-one education and patient navigation. It is also possible that the implementation of FIT specimen collection demonstration may have contributed to patient self-efficacy in performing the specimen collection and thus, the higher rates of compliance with FIT over gFOBT.…”

Patients’ Perceptions of Colorectal Cancer Screening Tests and Preparatory Education in Federally Qualified Health Centers

“…Whereas the traditional FOBT requires the patient to collect stool samples from three different bowel movements, the iFOBT, a similar but more sensitive screening test that detects hemoglobin in stool samples, only requires one sample and has no dietary restrictions [7]. The sampling procedure is relatively simple, making it a more patient-friendly procedure compared to guaiac-based or other forms of FOBT [8–10]. Although colonoscopy is considered to be the most thorough screening test, FOBTs/ iFOBTs have strong evidence of clinical effectiveness [11], and have been shown to lead to a 30% reduction in CRC mortality and a 20% reduction in CRC incidence with acceptable cost-effectiveness [12–15].…”

Making It Work: Health Care Provider Perspectives on Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

“…Therefore, more accessible alternatives, such as FOBT, should be promoted [11]. This is important in increasing accessibility of newer high sensitivity and specificity of single sample tests such as the fecal immunochemical test (FIT) [13]. The CRCS recommendation patterns in our study may be related to an organization's policies, which can enable or hinder provider behaviors.…”

“…Among the various CRCS modalities, FOBT has the strongest evidence of clinical effectiveness from randomized controlled trials [10]. FOBT leads to a 30% reduction in CRC mortality and a 20% reduction in CRC incidence [11, 12] with acceptable cost-effectiveness [10, 13]. …”