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Volume 345:555-560 August 23, 2001 Number 8 Next

	Full Text PDF Editorial by Detsky, A. S. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Fecal occult-blood testing and sigmoidoscopy have been recommended for screening for colorectal cancer, but the sensitivity of such combined testing for detecting neoplasia is uncertain. At 13 Veterans Affairs medical centers, we performed colonoscopy to determine the prevalence of neoplasia and the sensitivity of one-time screening with a fecal occult-blood test plus sigmoidoscopy.

Methods Asymptomatic subjects (age range, 50 to 75 years) provided stool specimens on cards from three consecutive days for fecal occult-blood testing, which were rehydrated for interpretation. They then underwent colonoscopy. Sigmoidoscopy was defined as examination of the rectum and sigmoid colon during colonoscopy, and sensitivity was estimated by determining how many patients with advanced neoplasia had an adenoma in the rectum or sigmoid colon. Advanced colonic neoplasia was defined as an adenoma 10 mm or more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer.

Results A total of 2885 subjects returned the three specimen cards for fecal occult-blood testing and underwent a complete colonoscopic examination. A total of 23.9 percent of subjects with advanced neoplasia had a positive test for fecal occult blood. As compared with subjects who had a negative test for fecal occult blood, the relative risk of advanced neoplasia in subjects who had a positive test was 3.47 (95 percent confidence interval, 2.76 to 4.35). Sigmoidoscopy identified 70.3 percent of all subjects with advanced neoplasia. Combined one-time screening with a fecal occult-blood test and sigmoidoscopy identified 75.8 percent of subjects with advanced neoplasia.

Conclusions One-time screening with both a fecal occult-blood test with rehydration and sigmoidoscopy fails to detect advanced colonic neoplasia in 24 percent of subjects with the condition.

Source Information

From the Veterans Affairs medical centers in Portland, Oreg. (D.A.L.), and Perry Point, Md. (D.G.W.).

Other authors from Veterans Affairs medical centers were William V. Harford, M.D., Dallas; Dennis J. Ahnen, M.D., Denver; Dawn Provenzale, M.D., Durham, N.C.; Stephen J. Sontag, M.D., Thomas G. Schnell, M.D., and Gregorio Chejfec, M.D., Hines, Ill.; Donald R. Campbell, M.D., Kansas City, Mo.; Theodore E. Durbin, M.D., Long Beach, Calif.; John H. Bond, M.D., Douglas B. Nelson, M.D., and Stephen L. Ewing, M.D., Minneapolis; George Triadafilopoulos, M.D., Palo Alto, Calif.; Francisco C. Ramirez, M.D., Phoenix, Ariz.; John G. Lee, M.D., Judith F. Collins, M.D., M. Brian Fennerty, M.D., Tiina K. Johnston, R.N., Ed.M., and Christopher L. Corless, M.D., Ph.D., Portland, Oreg.; Kenneth R. McQuaid, M.D., San Francisco; Harinder Garewal, M.D., Ph.D., Richard E. Sampliner, M.D., Thomas G. Morales, M.D., and Ronnie Fass, M.D., Tucson, Ariz.; and Robert E. Smith, M.D., and Yogesh Maheshwari, M.D., White River Junction, Vt.

Address reprint requests to Dr. Lieberman at the Division of Gastroenterology, Oregon Health Sciences University, Portland Veterans Affairs Medical Center P3-GI, P.O. Box 1034, Portland, OR 97207, or at lieberma{at}ohsu.edu.

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