title: Guaiac versus immunochemical tests: faecal occult blood test screening for colorectal cancer in a rural community.
abstract: 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.
authors.affiliation: School of Public Health and Centre for Health Research, Qld University of Technology, Queensland.
authors.forename: Karen
authors.initials: K
authors.lastname: Hughes
authors.forename: Barbara
authors.initials: B
authors.lastname: Leggett
authors.forename: Christopher
authors.initials: C
authors.lastname: Del Mar
authors.forename: John
authors.initials: J
authors.lastname: Croese
authors.forename: Stephen
authors.initials: S
authors.lastname: Fairley
authors.forename: John
authors.initials: J
authors.lastname: Masson
authors.forename: Joanne
authors.initials: J
authors.lastname: Aitken
authors.forename: Alexandra
authors.initials: A
authors.lastname: Clavarino
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
authors.forename: Warren R
authors.initials: WR
authors.lastname: Stanton
authors.forename: Shilu
authors.initials: S
authors.lastname: Tong
authors.forename: Beth
authors.initials: B
authors.lastname: Newman
mesh_terms: 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
chemical_list: D007202:Indicators and Reagents; D006138:Guaiac