title: Evaluating the long-term effect of FOBT in colorectal cancer screening.
abstract: BACKGROUND
  Cancer screening has been effective in detecting tumors early before symptoms appear. However, the effectiveness of the regular fecal occult blood test (FOBT) in colorectal cancer in the long term has not been quantified.
  
  
  METHODS
  We applied the statistical method developed by Wu and Rosner using data from the Minnesota Colon Cancer Control Study (MCCCS). All initially asymptomatic participants were classified into four mutually exclusive groups: true-early-detection, no-early-detection, over-diagnosis, and symptom-free life; human lifetime was treated as a random variable and is subject to competing risks. All participants in the screening program will eventually fall into one of the four outcomes above. Predictive inferences on the percentages of the four outcomes for both genders were made using the Minnesota study data.
  
  
  RESULTS
  Depending on gender, screening frequency and age at the initial screening, for all participants the probability of "symptom-free-life" varies between 95.3% and 96.6%; the probability of "true-early-detection" is 1.9-3.8%; the probability of no-early-detection is 0.3-2.0%; the probability of over-diagnosis is 0.16-0.3%. Among those with colorectal cancer detected by regular FOBT, the probability of over-diagnosis is lower than expected and is between 6% and 9%, with 95% CI (2.5%, 21.3%) for females and (1.9%, 44.7%) for males. The probability of true-early-detection increases as screening interval decreases. The probability of no-early-detection decreases as screening interval decreases.
  
  
  CONCLUSIONS
  The probability of over-diagnosis among the screen-detected cases is not as high as previously thought. We hope this outcome can provide valuable information on the effectiveness of the FOBT in colorectal cancer detection in the long term.
authors.affiliation: Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40202, USA. d0luo001@louisville.edu
authors.forename: Dianhong
authors.initials: D
authors.lastname: Luo
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Cambon
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Wu
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000097:blood* / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007159:Immunologic Tests; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D011933:Reagent Kits, Diagnostic
chemical_list: D011933:Reagent Kits, Diagnostic