Randomised controlled trial of faecal-occult-blood screening for colorectal cancer

Hardcastle, J. D.; Chamberlain, Jocelyn; Robinson, Michael H.; Moss, Susan; Amar, S. S.; Balfour, T. W.; James, Peter; Mangham, C M

doi:10.1016/s0140-6736(96)03386-7

Cited by 2,370 publications

(777 citation statements)

References 25 publications

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“…Screening for CRC has been shown to decrease CRC mortality for average risk as well as high-risk individuals (Atkin et al 2010;Hardcastle et al 1996;Hewitson et al 2008;Kronborg et al 1996;Mandel et al 1993;Schoen et al 2012). The American College of Physicians (ACP) recommends that clinicians assess risk for CRC in all adults, and that average-risk individuals screen for CRC using fecal occult blood testing (FOBT) annually, flexible sigmoidoscopy every 5 years, or optical colonoscopy every 10 years, beginning at age 50 and continuing until age 75 (Qaseem et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of an educational intervention on family physicians’ risk assessment and management of colorectal cancer

et al. 2014

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We developed a point-of-care tool indicating risk categories for colorectal cancer (CRC) based on family history (FH) and management recommendations tailored to risk. The study objective was to determine if this CRC Risk Triage/ Management Too would enable family physicians (FPs) to appropriately triage and make screening and genetics referral recommendations for patients with CRC FH. Baseline questionnaires were mailed to a random sample of FPs in Ontario and Newfoundland, Canada. Participants were asked to use the tool for 3 months and then complete a follow-up questionnaire. The primary outcomes were correct responses to questions regarding CRC risk category, screening method, starting age, frequency, and decision to refer to genetics, for eight clinical vignettes. The study was completed by 75/121 (62 %) participating FPs. Most (77 %) agreed they routinely recommended fecal occult blood testing for average risk patients age ≥50. This did not change significantly following the intervention. There was a significant increase in confidence in CRC risk assessment (52 % pre; 88 % post; p<0.001), correct management recommendations for patients with CRC FH (51 % pre; 84 % post; p<0.001), and improvement in total mean scores on outcome measures for all vignettes. Most demonstrates the value of point-of-care tools and illustrates a process for development, evaluation, and dissemination of tools needed by FPs if potential impacts of genomic advances are to be achieved.

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Section: Introductionmentioning

confidence: 99%

Efficacy of an educational intervention on family physicians’ risk assessment and management of colorectal cancer

et al. 2014

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“…Identification of high-risk patients using a less invasive test would decrease the number of such procedures required. Carcinoembryonic antigen (CEA) is of proven benefit in prognosis and follow-up, but has limited sensitivity (30 -40%) for early CRC (Fletcher, 1986), whereas serial faecal occult blood testing is proven to reduce CRC mortality but suffers from significant false-negative and falsepositive rates (Hardcastle et al, 1989;Mandel et al, 1993;Kronberg et al, 1996). Stool DNA analysis for multiple targets has shown sensitivity of 71 -91% in preliminary studies and larger studies are underway (Ahlquist et al, 2000;Dong et al, 2001); however, a serum-based assay with equivalent sensitivity and specificity would be more acceptable to many patients.…”

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confidence: 99%

Identification of serum biomarkers for colon cancer by proteomic analysis

et al. 2006

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Colorectal cancer (CRC) is often diagnosed at a late stage with concomitant poor prognosis. Early detection greatly improves prognosis; however, the invasive, unpleasant and inconvenient nature of current diagnostic procedures limits their applicability. No serum-based test is currently of sufficient sensitivity or specificity for widespread use. In the best currently available blood test, carcinoembryonic antigen exhibits low sensitivity and specificity particularly in the setting of early disease. Hence, there is great need for new biomarkers for early detection of CRC. We have used surface-enhanced laser desorbtion/ionisation (SELDI) to investigate the serum proteome of 62 CRC patients and 31 noncancer subjects. We have identified proteins (complement C3a des-arg, a1-antitrypsin and transferrin) with diagnostic potential. Artificial neural networks trained using only the intensities of the SELDI peaks corresponding to identified proteins were able to classify the patients used in this study with 95% sensitivity and 91% specificity.

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“…Even in countries where up-to-date therapeutic options are available, more than 40% of CRC patients still die from the disease within 5 years after diagnosis (Brenner, 2002;Brenner et al, 2005). As survival is considerably better for early, localised CRC than for later stages and CRC might be prevented altogether by detection and removal of precancerous lesions, enhanced screening will be of crucial importance for further progress in reducing the burden of the disease.Experience with faecal occult blood testing (FOBT) has shown the possibility of reducing both incidence and mortality owing to screening based on stool tests (Hardcastle et al, 1996;Mandel et al, 1999Mandel et al, , 2000 and the advantages of this screening modality regarding acceptability and practicality compared with invasive screening options. However, given the limitations of FOBT, mainly the inherently low sensitivity to detect precancerous or cancerous lesions, there is still need for improvement.…”

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confidence: 99%

“…Experience with faecal occult blood testing (FOBT) has shown the possibility of reducing both incidence and mortality owing to screening based on stool tests (Hardcastle et al, 1996;Mandel et al, 1999Mandel et al, , 2000 and the advantages of this screening modality regarding acceptability and practicality compared with invasive screening options. However, given the limitations of FOBT, mainly the inherently low sensitivity to detect precancerous or cancerous lesions, there is still need for improvement.…”

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confidence: 99%

Tumour M2-PK as a stool marker for colorectal cancer: comparative analysis in a large sample of unselected older adults vs colorectal cancer patients

et al. 2007

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Stool testing based on tumour-derived markers might offer a promising approach for non-invasive colorectal cancer (CRC) screening. The aim of this study was to estimate the potential of a new test for faecal tumour M2-PK to discriminate patients with CRC from a large sample of unselected older adults. Faecal tumour M2-PK concentrations were determined in 65 CRC patients and in a population-based sample of 917 older adults (median age: 65 and 62 years, respectively). Sensitivity and specificity of the test were calculated at different cutoff values, and receiver-operating characteristic curves (ROC) were constructed to visualise the discriminatory power of the test. The median (interquartile range) faecal tumour M2-PK concentration was 8.6 U ml À1 (2.8 -18.0) among CRC patients and o2 U ml À1 (o2 -3.2; Po0.0001) in the population sample. At a cutoff value of 4 U ml À1 , sensitivity (95% confidence interval) was 85% (65 -96%) for colon cancer and 56% (41 -74%) for rectum cancer. Specificity (95% confidence interval) was estimated to be 79% (76 -81%). Given the comparatively high sensitivity of the tumour M2-PK stool test (especially for colon cancer) and its simple analysis, the potential use of the test for early detection of CRC merits further investigation. Possibilities to enhance specificity of the test should be explored. Colorectal cancer (CRC) is one of the leading causes of cancerrelated morbidity and mortality worldwide (Ferlay et al, 2004). Even in countries where up-to-date therapeutic options are available, more than 40% of CRC patients still die from the disease within 5 years after diagnosis (Brenner, 2002;Brenner et al, 2005). As survival is considerably better for early, localised CRC than for later stages and CRC might be prevented altogether by detection and removal of precancerous lesions, enhanced screening will be of crucial importance for further progress in reducing the burden of the disease.Experience with faecal occult blood testing (FOBT) has shown the possibility of reducing both incidence and mortality owing to screening based on stool tests (Hardcastle et al, 1996;Mandel et al, 1999Mandel et al, , 2000 and the advantages of this screening modality regarding acceptability and practicality compared with invasive screening options. However, given the limitations of FOBT, mainly the inherently low sensitivity to detect precancerous or cancerous lesions, there is still need for improvement. Therefore, the development of stool tests with better performance characteristics has become a focus of current research, both in the field of DNAbased stool markers and in the field of protein-based stool markers. For some of the new tests, preliminary results regarding sensitivity and specificity are encouraging but evidence of the performance of the new methods is mostly restricted to small-scale investigations in the clinical setting (Haug and Brenner, 2005a).A novel approach based on the detection of proteins in stool derived from neoplastic colonocytes is the quantitative measurement of faecal tum...

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Randomised controlled trial of faecal-occult-blood screening for colorectal cancer

Cited by 2,370 publications

References 25 publications

Efficacy of an educational intervention on family physicians’ risk assessment and management of colorectal cancer

Efficacy of an educational intervention on family physicians’ risk assessment and management of colorectal cancer

Identification of serum biomarkers for colon cancer by proteomic analysis

Tumour M2-PK as a stool marker for colorectal cancer: comparative analysis in a large sample of unselected older adults vs colorectal cancer patients

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