Guaiac based faecal occult blood testing for colorectal cancer screening: an obsolete strategy?

Young, Graeme P.; Fraser, Callum G.; Halloran, Stephen P; Cole, Steven

doi:10.1136/gutjnl-2011-301810

Cited by 27 publications

(25 citation statements)

References 19 publications

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“…22 Quantitative FIT kits are more expensive than gFOBT but, being based on automated immunoturbidimetric analytical systems, provide high-quality, reproducible results with fewer staff required to handle the workload in screening programmes. Visual interpretation of test results is eliminated.…”

Section: Discussionmentioning

confidence: 99%

Use of a faecal immunochemical test narrows current gaps in uptake for sex, age and deprivation in a bowel cancer screening programme

Digby

McDonald²,

Strachan³

et al. 2013

J Med Screen

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Objectives To investigate the characteristics of participants screened for bowel cancer using a faecal immunochemical test for haemoglobin (FIT). Setting Scottish Bowel Screening Programme. Methods 65909 men and women in two NHS Boards, aged 50 to 74, were invited to participate in an evaluation of FIT as a first-line test. Uptake was calculated by sex, age in quintiles, and deprivation in quintiles, and compared with a group who had completed a guaiac faecal occult blood test (gFOBT) and for whom details of sex, age and deprivation were well documented. Results FIT kits from 38672 participants were tested. The overall uptake of 58.7% was significantly higher than the 53.9% for gFOBT (p , 0.0001). Uptakes in the two NHS Boards were 57.6% and 54.4% for men and 63.2% and 59.1% for women, higher than the 49.5% and 58.1% completing gFOBT. Uptake was higher for FIT than gFOBT in all age and deprivation quintiles for both men and women in both NHS Boards. The difference in uptake fell with age for men but rose for women; the increase in uptake was greater for men than women. Uptake fell as deprivation decreased for both sexes, and was similar in both NHS Boards. Conclusions Use of FIT increases uptake over gFOBT, and the greatest increases are seen in men, younger participants, and more deprived individuals, groups for which an increase in uptake is likely to be beneficial. The results support a move to FIT as a first-line screening test for those countries still using gFOBT.

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Section: Discussionmentioning

confidence: 99%

Use of a faecal immunochemical test narrows current gaps in uptake for sex, age and deprivation in a bowel cancer screening programme

Digby

McDonald²,

Strachan³

et al. 2013

J Med Screen

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“…12 This has led to a plea that more highquality studies on the diagnostic performance of FOBT and symptom combinations in primary care settings should be supported. 21 However, the ongoing evidence is that gFOBT should indeed be considered as obsolete 22 and use should continue to be eliminated, although the body of published work does give many valuable insights on the role of detection of blood in faeces. Efforts should be directed to the wider and appropriate use of better tests for the presence of blood in faeces.…”

Section: Introductionmentioning

confidence: 99%

A future for faecal haemoglobin measurements in the medical laboratory

Fraser

2012

Ann Clin Biochem

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Guaiac-based faecal occult blood tests (gFOBT) are still used in asymptomatic population bowel screening programmes but are being replaced by faecal immunochemical tests (FIT) for haemoglobin. gFOBT have many well-documented disadvantages and there is little evidence for their use in assessment of the symptomatic. Many laboratories have eliminated gFOBT from their approved repertoires by invoking the authoritative published guidelines. Data continue to accumulate that gFOBT are obsolete. FIT are available in two formats, qualitative and quantitative, the latter having advantages that the faecal haemoglobin concentrations are measured and cut-off concentrations that stimulate further investigation can be user-defined. There is growing evidence that FIT would be useful in a spectrum of clinical settings in addition to screening. All laboratories should have FIT in their existing repertoire. For some uses, qualitative FIT would be adequate. However, much evidence has accumulated that measurements of faecal haemoglobin concentrations are beneficial for the assessment of both disease severity and the future risk of colorectal neoplasia. Interpretation requires appreciation that faecal haemoglobin concentrations are higher in men than women and rise with age. It might well be that risk scoring systems that take gender and age into account, possibly with other factors including symptoms, will benefit individuals. Laboratories should consider how quantitative faecal haemoglobin measurements could be brought into routine practice and included in their forward planning. External quality assessment is needed. Specialists in laboratory medicine are urged to play a significant role in the research and development still required to make this a truly mature investigation.

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“…In the interpretation of our results, there are several limitations that need to be taken into account. First, although Hemoccult II is no longer recommended in the US, we included it in our analyses because its effectiveness demonstrated in randomized controlled trials is considered the minimum that needs to be achieved by a new test . Furthermore, it allowed illustration of how the benchmark for new tests has changed with the availability of FOBTs with improved sensitivity compared to Hemoccult II.…”

Section: Discussionmentioning

confidence: 99%

“…The effectiveness of Hemoccult II demonstrated in randomized controlled trials is considered the minimum that needs to be achieved by an NIT for it to be a viable option, while FIT is considered to be the best available FOBT. 33 The assumptions and parameters regarding test…”

Section: Discussionmentioning

confidence: 99%

“…We focused on these two FOBTs because they represent the upper and lower bounds of diagnostic performance of existing FOBTs. The effectiveness of Hemoccult II demonstrated in randomized controlled trials is considered the minimum that needs to be achieved by an NIT for it to be a viable option, while FIT is considered to be the best available FOBT . The assumptions and parameters regarding test performance characteristics, costs related to screening, and CRC treatment costs are summarized in Tables and .…”

Section: Methodsmentioning

confidence: 99%

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Development of new non‐invasive tests for colorectal cancer screening: The relevance of information on adenoma detection

Haug

Knudsen

Lansdorp–Vogelaar

et al. 2014

Intl Journal of Cancer

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Researchers are actively pursuing the development of a new non-invasive test (NIT) for colorectal cancer (CRC) screening as an alternative to fecal occult blood tests (FOBTs). The majority of pilot studies focus on the detection of invasive CRC rather than precursor lesions (i.e., adenomas). We aimed to explore the relevance of adenoma detection for the viability of an NIT for CRC screening by considering a hypothetical test that does not detect adenomas beyond chance. We used the Simulation Model of Colorectal Cancer (SimCRC) to estimate the effectiveness of CRC screening and the lifetime costs (payers’ perspective) for a cohort of US 50-year-olds to whom CRC screening is offered from age 50–75. We compared annual screening with guaiac and immunochemical FOBTs (with sensitivities up to 70% and 24% for CRC and adenomas, respectively) to annual screening with a hypothetical NIT (sensitivity of 90% for CRC, no detection of adenomas beyond chance, specificity and cost similar to FOBTs). Screening with the NIT was not more effective, but was 29–44% more costly than screening with FOBTs. The findings were robust to varying the screening interval, the NIT’s sensitivity for CRC, adherence rates favoring the NIT, and the NIT’s unit cost. A comparative modelling approach using a model that assumes a shorter adenoma dwell time (MISCAN-COLON) confirmed the superiority of the immunochemical FOBT over a NIT with no ability to detect adenomas. Information on adenoma detection is crucial to determine whether a new NIT is a viable alternative to FOBTs for CRC screening. Current evidence thus lacks an important piece of information to identify marker candidates that hold real promise and deserve further (large-scale) evaluation.

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Guaiac based faecal occult blood testing for colorectal cancer screening: an obsolete strategy?

Cited by 27 publications

References 19 publications

Use of a faecal immunochemical test narrows current gaps in uptake for sex, age and deprivation in a bowel cancer screening programme

Use of a faecal immunochemical test narrows current gaps in uptake for sex, age and deprivation in a bowel cancer screening programme

A future for faecal haemoglobin measurements in the medical laboratory

Development of new non‐invasive tests for colorectal cancer screening: The relevance of information on adenoma detection

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