Guaiac versus immunochemical tests: faecal occult blood test screening for colorectal cancer in a rural community.
OBJECTIVE
To describe patient participation and clinical performance in a colorectal cancer (CRC) screening program utilising faecal occult blood test (FOBT).


METHODS
A community-based intervention was conducted in a small, rural community in north Queensland, 2000/01. One of two FOBT kits--guaiac (Hemoccult-II) or immunochemical (!nform)--was assigned by general practice and mailed to participants (3,358 patients aged 50-74 years listed with the local practices).


RESULTS
Overall participation in FOBT screening was 36.3%. Participation was higher with the immunochemical kit than the guaiac kit (OR=1.9, 95% CI 1.6-2.2). Women were more likely to comply with testing than men (OR=1.4, 95% CI 1.2-1.7), and people in their 60s were less likely to participate than those 70-74 years (OR=0.8, 95% CI 0.6-0.9). The positivity rate was higher for the immunochemical (9.5%) than the guaiac (3.9%) test (chi2=9.2, p=0.002), with positive predictive values for cancer or adenoma of advanced pathology of 37.8% (95% CI 28.1-48.6) for !nform and 40.0% (95% CI 16.8-68.7) for Hemoccult-II. Colonoscopy follow-up was 94.8% with a medical complication rate of 2-3%.


CONCLUSIONS
An immunochemical FOBT enhanced participation. Higher positivity rates for this kit did not translate into higher false-positive rates, and both test types resulted in a high yield of neoplasia.


CONCLUSIONS
In addition to type of FOBT, the ultimate success of a population-based screening program for CRC using FOBT will depend on appropriate education of health professionals and the public as well as significant investment in medical infrastructure for colonoscopy follow-up.
Hughes
Karen
K
School of Public Health and Centre for Health Research, Qld University of Technology, Queensland.
Leggett
Barbara
B
Del Mar
Christopher
C
Croese
John
J
Fairley
Stephen
S
Masson
John
J
Aitken
Joanne
J
Clavarino
Alexandra
A
Janda
Monika
M
Stanton
Warren R
WR
Tong
Shilu
S
Newman
Beth
B
D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003159:Community-Institutional Relations; D005260:Female; D006138:Guaiac; D006801:Humans; D007120:Immunochemistry / Q000379:methods*; D007202:Indicators and Reagents; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011793:Queensland / Q000453:epidemiology; D015203:Reproducibility of Results; D012424:Rural Population / Q000706:statistics & numerical data*; D012737:Sex Factors
D007202:Indicators and Reagents; D006138:Guaiac