Does a risk questionnaire add anything to a colorectal screening project? Report of a 3-year screening experience.
A questionnaire to detect persons at high risk for colorectal cancer was used in conjunction with fecal occult blood tests in a 3-year screening program in Northern Israel. Screening was offered to 2,590 persons over 40 years of age and accepted by 1,797 (compliance of 69.4%). In the subsequent 2 years, occult blood testing (Hemoccult II) was offered to those who had had negative tests (compliance rate of 99.6% and 100%). Six hundred and thirty persons (35.1%) had risk factors according to the questionnaire, and 195 of them underwent colonoscopy, with a predictive value of 15.9% for a neoplastic lesion. The Hemoccult II test was positive in 71 participants (4.0%) of whom 67 were investigated with a similar predictive value for neoplastic lesion (16.4%). In the second and third annual screening, the fecal occult blood test was positive in 29 (2.6%) and 27 (2.5%), and had a two and three times higher predictive value for neoplastic lesions, respectively. This was accompanied by a decrease in the cost of discovery. In all three stages, an adenomatous polyp was found in 48, and cancer in 10 participants (2.6% and 0.5% of the 1,797 original participants). Although a questionnaire may be fruitful in colorectal cancer screening, the higher number of participants subjected to further examinations makes this approach very expensive. The annual stool examination for occult blood has a higher predictive value for colonic neoplasm and a lower cost than a one stage, broader population based, study.
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Gastroenterology Unit, Rebecca Sieff Government Hospital, Safed, Israel.
D000328:Adult; D001466:Barium Sulfate / Q000008:administration & dosage; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003951:Diagnostic Errors; D004733:Enema; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D008875:Middle Aged; D009780:Occult Blood; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
D001466:Barium Sulfate