title: The fecal occult blood test as a tool for improved outpatient qualification for colonoscopy. A single-center experience and 10-year follow-up survey.
abstract: OBJECTIVE
  Colonoscopy is not widely and easily available in all countries, even for symptomatic patients. This is one of the causes of tumors not being diagnosed until an advanced stage. The aim of this study was to estimate the efficacy of the fecal occult blood test (FOBT) in the diagnostic work-up of outpatients referred to a colorectal unit due to indistinct abdominal symptoms.
  
  
  METHODS
  Among 10418 consecutive symptomatic individuals referred to the outpatient clinic, an immunochemical FOBT (Hem-Check 1®) was recommended for 9432 patients with indistinct symptoms as a tool for qualifying them for colonoscopy. All the subjects were treated according to their diagnosis and followed-up for the next 10 years.
  
  
  RESULTS
  Colorectal cancer (CRC) was diagnosed in 535 individuals: 393/986 (39.9%) among patients with red-flag symptoms, and 142/951 (14.9%) of individuals with indistinct symptoms and a positive FOBT. In the latter group, less-advanced tumors, classed as such using Dukes' classification, were twice as common and more advanced CRC occurred twice as seldom than in the former. Cancer recurrence-free and overall survival periods after surgical treatment for CRC were significantly longer in patients with indistinct symptoms who qualified for diagnostic procedures on the basis of a positive FOBT.
  
  
  CONCLUSIONS
  Patients with symptoms suggesting organic colon disease had a worse prognosis compared to individuals with non-specific symptoms. If bowel endoscopy is not widely and easily available, qualification for colonoscopy on the basis of alarm symptoms and a positive FOBT seems to be an effective strategy in early CRC diagnosis.
authors.affiliation: Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Chair of Vascular Surgery and Angiology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland; Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Banaszkiewicz
authors.affiliation: Chair of Vascular and Internal Diseases, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland. Electronic address: budz@cps.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Budzyński
authors.affiliation: Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Tojek
authors.affiliation: Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Jarmocik
authors.affiliation: Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Frasz
authors.affiliation: Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Mrozowski
authors.affiliation: Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Jan Biziel University Hospital No. 2 in Bydgoszcz, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Świtoński
authors.affiliation: Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Chair of Vascular Surgery and Angiology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland; Chair of Vascular Surgery and Angiology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Jawień
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods*; D005243:Feces / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010045:Outpatients; D011379:Prognosis; D011795:Surveys and Questionnaires; D015996:Survival Rate
keywords: Colonoscopy; Colorectal cancer diagnosis; Fecal occult blood test; Outpatients; Prognosis