Screening program for colorectal cancer: effect on stage distribution.
BACKGROUND
The prognosis of patients with colorectal cancer is related to stages of disease at the time of diagnosis. Ultimately, the goal of fecal occult blood test (FOBT) screening programs is to reduce colorectal cancer mortality.


METHODS
We reviewed the medical records and pathology reports of all 60 Harvard Community Health Plan (HCHP) members who were diagnosed as having colorectal cancer during the 2 years after our FOBT screening program began. The stage distribution of these 60 cases were compared with that of 76 cases diagnosed at HCHP before the FOBT screening program was started.


RESULTS
Eight of 60 colorectal cancers diagnosed after the FOBT screening program was begun (13%) were diagnosed as a result of a positive screening test (Group I). The remaining 52 cases (87%) were diagnosed as a result of symptoms, physical findings, and/or the presence of anemia (Group II). Three of 8 Group I colorectal cancers (38%) were stage A, as compared with 8 of 52 of Group II colorectal cancers (15%). None of the 8 Group I colorectal cancers was stage D (metastatic) at the time of diagnosis, as compared with 11 of 52 Group II colorectal cancers (21%).


CONCLUSIONS
We observed a favorable shift in the stage distribution of colorectal cancers diagnosed at HCHP after the FOBT screening program began (p less than .05). The shift was not attributable only to FOBT screening. We believe that the educational components of the program were important to its effectiveness. Our results support continued use of FOBT at HCHP.
Kaye
J A
JA
Harvard Community Health Plan, Boston, MA.
Shulman
L N
LN
D001900:Boston; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration* / Q000706:statistics & numerical data; D009780:Occult Blood; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation / Q000706:statistics & numerical data