Self-reported dark red bleeding as a marker comparable with occult blood testing in screening for large bowel neoplasms

Abstract

The study was designed to determine the prevalence of large bowel symptoms in an adult working population and to assess their value in screening for large bowel neoplasms. A symptom questionnaire was sent to workers in two large organizations and the results were compared with faecal occult blood testing in the same individuals using Haemoccult (Eaton Laboratories). Completed symptom questionnaires and Haemoccult test kits were returned by 916 out of a total of 1805 employees over the age of 40 (compliance 50.7 per cent). Twenty-eight (3.1 per cent) were Haemoccult positive and 114 (12.4 per cent) had one or more symptoms. All positives (129 persons) were examined by flexible sigmoidoscopy and barium enema. No cancer was found but 7 patients with adenomas greater than 10 mm diameter were discovered. Each of the 7 patients reported at least one symptom (dark red bleeding in 4, bright red bleeding in 2 and diarrhoea in 1) and 6 were Haemoccult positive. There was no individual with a Haemoccult positive adenoma without symptoms. Predictive values for adenomas over 10 mm for Haemoccult positive tests (21 per cent), self-reported dark bleeding (16 per cent) and diarrhoea (17 per cent), were significantly higher than for other symptoms. The predictive value rose significantly to 46 per cent for Haemoccult-positive patients who in addition had at least one symptom (P less than 0.05) and to 57 per cent for Haemoccult positive with dark bleeding. These combinations of Haemoccult- and symptom-positive results increased the specificity of 97.6 per cent for Haemoccult alone to values over 99 per cent without reducing sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Rectal bleeding in general and hospital practice; ‘the tip of the iceberg’

“…Dark red bleeding is commonly thought to be a useful discriminating factor, but its high incidence in patients with benign disease shown in this study decreases its value and previous studies on this have been contradictory [ 15–17].…”

An industry based approach to colorectal cancer screening in an asymptomatic population

“…In one previous study workers over 40 years of age in two companies were invited to receive a Haemoccult kit and complete a symptom questionnaire. 22 Although overall compliance was 51% with women participating significantly more than men (61% v 47%), uptake according to age and occupation were not reported. The intense publicity with lectures, leaflets, and small group discussion may have encouraged greater participation than in our study.…”

Symptoms and signs in patients with colorectal cancer

“…In Portsmouth, UK, a prevalence of 18% was noted for rectal bleeding in the previous year in individuals over 16 years [24]. All these studies also demonstrated a higher prevalence of rectal bleeding in younger age groups [16,[20][21][22][23][24][25][26].…”