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PubMed1991

Fecal occult blood testing. Guidelines for follow-up after positive findings.

Fecal occult blood testing should be performed under optimal conditions to minimize false-positive test results. Obvious bleeding from the rectum or other sources during the test period should be investigated and testing should be postponed. When a fecal occult blood test is positive, colonoscopy is recommended as the definitive method of diagnosis and often of treatment. When a complete colonoscopy cannot be performed, sigmoidoscopy with air-contrast barium enema is the next best alternative for direct visualization of the distal bowel and indirect investigation of the proximal colon.

Colonoscopy↗
PubMedDate not supplied

Immunologic detection of fecal occult blood from upper digestive tract diseases.

BACKGROUND/AIMS: This study was conducted to evaluate the accuracy of the immunochemical occult blood test for upper digestive tract diseases. METHODOLOGY: The test was performed on 226 subjects, including 124 upper digestive tract diseases (12 ulcerative esophagitis cases, 10 esophageal cancer cases, 33 gastric ulcer cases, 33 gastric cancer cases, and 36 duodenal ulcer cases), 34 colorectal cancer cases, and 68 healthy subjects, after which, the accuracy of this test was evaluated. RESULTS: The test was positive 23 in upper digestive tract diseases (2 in ulcerative esophagitis, 2 in esophageal cancer, 5 in gastric ulcer, 8 in gastric cancer, 6 in duodenal ulcer), 31 in colorectal cancer, and 3 in healthy subjects, respectively. Thus, the sensitivity was 19% for upper digestive tract diseases (16.7% for ulcerative esophagitis, 20% for esophageal cancer, 15% for gastric ulcer, 24% for gastric cancer, 20% for duodenal ulcer) and 91% for colorectal cancer, and the specificity was 96%. Significant difference was noted in the sensitivity between upper digestive tract diseases and colorectal cancers (p0.001), whereas there was no difference among 5 upper digestive tract diseases. CONCLUSIONS: These results indicate that the immunochemical occult blood is inadequate as means for detection of upper digestive tract diseases, and that an examination of upper digestive tract is unnecessary in cases where the immunochemical occult blood test is positive, but there is no evidence of diseases in colon and rectum.

Esophageal Diseases↗
PubMed1977

Feasibility of fecal occult-blood testing for detection of colorectal neoplasia: debits and credits.

A screening program for colorectal cancer and adenomas has been applied to 6,579 mostly asymptomatic men and women age 40 years and older utilizing fecal occult-blood testing followed by investigation of patients with positive slides by air-contrast barium enema and colonoscopy. A control population of 7,325 patients had sigmoidoscopy only and no occult-blood testing. Approximately 1% of the patients had positive slides; most patients had only one or two slides positive. Approximately 50% of patients with positive slides had significant neoplastic lesions, including 23 patients with large adenomas and 7 patients with cancers. Pathological staging of cancers was more favorable in the screened asymptomatic group as compared with the control group. Neoplastic lesions seen on sigmoidoscopy in screened patients who had negative fecal occult-blood tests included 2 cancers and 15 large adenomas. Reasons for false negativity include possible conversion of initially positive slides to negative. Screening for colorectal cancer and adenomas with fecal occult-blood testing appears to be feasible approach with good patient compliance, and manageable rate of positive slides productive of a high percentage of neoplastic lesions. The number of false-positives seems to be low. False negativity has been observed and will require further study.

Adenoma↗
PubMed1986

Mass screening for colorectal cancer by testing fecal occult blood.

The validity of screening for colorectal cancer by testing for occult blood on 2 successive days was evaluated over a 2-year period beginning April 1980 by testing 9449 individuals without symptoms. The Shionogi slide (Shionogi Pharmaceutical Co., Osaka, Japan), a commercial guaiac-impregnated slide with moderate sensitivity, was used for screening subjects under dietary restriction. Of the 1401 persons (14.8%) who had a positive reaction for occult blood, 858 (61.2%) received further diagnostic examinations, and 265 of them proved to have one or more abnormalities of the gastrointestinal tract. Colorectal cancer was detected in 11 persons and polyps in 91 persons. Eight of the cancers were in an early stage. This screening method was found to be suitable for large-scale mass screening, and appears to have high diagnostic value.

Adult↗
PubMed2001

Population colorectal cancer screening with fecal occult blood test.

Screening for early detection of colorectal cancer using fecal occult blood testing has been shown to be effective in reducing mortality from this disease. The largest Health Maintenance Organization in Israel initiated the use of Hemoccult Sensa in 1992 to evaluate the field performance of this test. All primary care physicians were invited to order home-based tests for their asymptomatic patients 50-74 years of age. This report summarizes the results of 45,166 tests performed, 22,193 in the prevalence round. Seventy-eight cancers, 60 patients with adenomas, and 163 patients with polyps were detected, yielding a cancer detection rate of 2.61/1,000 screened in the prevalence round. Of these, 21.6% were in the right colon. Of screen-detected cancers, 44.5% and 58.9% were detected in Dukes' A and in situ stages in the prevalence and incidence rounds, correspondingly. The overall estimated sensitivity of the test (median follow-up, 35 months) was 85.3% for the prevalence round with a specificity of 95.5%. The sensitivity for left-side tumors (87.9%) was higher than for right-side or rectal tumors (78.6%). The positive predictive value for cancer increased with increasing number of positive fields. Four or more positive fields had a positive predictive value for cancer of 16-26% and a positive predictive value of 46-71% for all tumors combined. Population screening with a sensitive fecal occult blood test performs well outside a trial setting, detecting a high proportion of expected tumors with favorable stage distribution. Given its proven power to significantly reduce mortality, use of this test is strongly advised to both medical organizations and the healthy population at average risk.

Aged↗
PubMed2001

The prevalence of visible and/or occult blood on anesthesia and monitoring equipment.

The Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) have attempted to stop the spread of blood-borne pathogens by issuing several recommendations and regulations. However, unless healthcare workers comply with these standards, they are not effective. In the anesthesia care environment, the anesthetist is responsible for ensuring that the equipment is clean, and disinfected, before use. We studied the prevalence of visible and occult blood on 6 types of anesthesia and monitoring equipment identified as ready for use in 28 operating suites, in 2 facilities. The sample consisted of 336 observations of the 6 types of equipment. The equipment was inspected for visible blood and then tested for occult blood using a 3-stage phenolphthalein test. Of the 336 observations, 110 (32.7%), were positive for occult blood with only 6 showing visible blood. The presence of blood on this equipment may be in direct violation of the OSHA Blood-borne Pathogen Standard and the infection control guidelines of the American Association of Nurse Anesthetists. Furthermore, the presence of blood on this equipment may increase the risk for nosocomial and occupational exposure to viral and bacterial pathogens. Recommendations were made to decrease the risks from this contamination by redesigning equipment, increasing the use of disposable equipment, and ensuring compliance with effective infection control practices.

Anesthesia↗
PubMed1993

[Evaluation of mass screening for colorectal cancer with 'sequential fecal occult blood test' in an asymptomatic population. Multicenter GI Research Group of Beijing Area of PLA].

In order to search for a reasonable screening method for colorectal cancer in accordance with the situations in China, we designed the sequential fecal occult blood test' (CFOBTS-->IFOBT-->colonoscopy) and compared with chemical fecal occult blood test (CFOBT) and immuno-fecal occult blood test (IFOBT). On the basis of our findings, SFOBT is not only sensitive, easy to perform but also economical as compared with CFOBT & IFOBT. By using the program of SFOBT, we carried out a mass screening of an asymptomatic population of 102,800 people, covering five provinces in northern China. The results are as follows: (1) The incidence of colorectal cancer in northern China was about 24.31/10(5); (2) 52% of colorectal cancer cases detected through the screening were classified as Dukes stages A or B, whereas only 36.83% are those clinically diagnosed (P < 0.05); (3) The incidence of colorectal cancer increased with age, the high-risk age group peak at 60-69 years; (4) 84% of cancer & 62.23% of adenomas were detected in sigmoid colon or rectum; (5) The incidence of colon tumour was significantly increased in subjects with family history of colon tumour as compared with those without; (6) Diet habits of different nationalities may not be related to the morbidity of colorectal cancer. In conclusion, mass screening for early detection of colorectal cancer following SFOBT program is suitable for the situations in China.

Adenoma↗
PubMedDate not supplied

Cost-effectiveness analysis of immunochemical occult blood screening for colorectal cancer among three fecal sampling methods.

BACKGROUND/AIMS: To evaluate the optimal sampling times of stool in immunochemical occult blood screening from the viewpoint of the cost-effectiveness. METHODOLOGY: A colorectal cancer screening was conducted in 5 municipalities (Matsumoto, Hata, Yamagata, Asahi, Sakai), Nagano prefecture, Japan in 1996. Each participant received a fecal occult blood test with 3 consecutive days. For the economic assessment of testing methods, the results of the 1st day, those of the 1st and 2nd days and those of the 3 consecutive days were used for a single-day method, a 2-day method, and a 3-day method. The average costs per detection of one cancer patient and diagnostic validity were evaluated among 3 months. RESULTS: The average costs for one cancer case detected were calculated to be $5924 for a single-day method, $6014 for a 2-day method, and $7123 for a 3-day method, respectively. The sensitivity and specificity were calculated to be 58% and 96% for a single-day method, 89% and 95% for a 2-day method, and 100% and 94% for a 3-day method, respectively, indicating a significant difference in the sensitivity between a single-day method and a 2-day as well as a 3-day method (P < 0.05), and in the specificity among 3 testing methods (P < 0.001). CONCLUSIONS: The present analysis suggests that a 2-day collection method is recommended in the immunochemical occult blood screening from the viewpoint of the cost-effectiveness as well as the diagnostic accuracy.

Adult↗
PubMed2002

Fecal occult blood testing for colorectal cancer: a perspective.

Colorectal cancer is an important health problem in western countries. Early detection of colorectal cancer reduces mortality. The best evidence for the effectiveness of screening for colorectal cancer is with annual or biennial fecal occult blood testing. While the benefit of fecal occult blood testing is small in absolute terms, the incremental cost-effectiveness of this screening strategy appears acceptable. Combining fecal occult blood testing with periodic flexible sigmoidoscopy or replacing it altogether with infrequent colonoscopy are theoretically attractive screening strategies, but the incremental costs and effectiveness of these more intensive screening strategies have not been well defined. Whether and how to implement population-based screening for colorectal cancer depends largely on available resources.

Colorectal Neoplasms↗
PubMed1997

Detection rate of immunochemical fecal occult blood test for colorectal adenomatous polyps with severe dysplasia.

This study was conducted to assess the accuracy of an immunochemical occult blood test for detecting colorectal adenomas with severe dysplasia, and to determine the relationship between the grading of adenomatous dysplasia and the results of this test. Sixteen colorectal adenomas under 1 cm with severe dysplasia, 65 adenomas under 1 cm with mild-to-moderate dysplasia, 65 adenomas 1 cm or larger with mild-to-moderate dysplasia, 65 colorectal cancers and 130 healthy controls were investigated. Each subject was tested with an immunochemical fecal occult blood test on 3 consecutive days, and the accuracy of the test was evaluated. The detection rate of this test was 13% for severe dysplasia under 1 cm, 45% for severe dysplasia 1 cm or more, 17% for mild-to-moderate dysplasia under 1 cm, 40% for mild-to-moderate dysplasia 1 cm or more, and 89% for colorectal cancers, and the false positive rate was 5%, showing a significant difference in the detection rate between severe dysplasias 1 cm or more and those under 1 cm (P < 0.05) as well as significant difference between severe dysplasias 1 cm or more and mild-to-moderate dysplasia under 1 cm (P < 0.01), and between cancers and adenomas (P < 0.001), whereas there was no significant difference between the detection rates for severe dysplasia 1 cm or more and mild-to-moderate dysplasia 1 cm or more. These results indicate that there is no association between the detection rate of this immunochemical occult blood test for adenomas and the grade of adenomatous dysplasia.

Adenoma↗
PubMed2002

[The value of using urinary red cell volume distribution curve of patients with positive urinary occult blood detected in a mass examination].

PURPOSE: We investigated the usefulness of the urinary red blood cell volume distribution curve (RVDC) for screening patients who are positive for asymptomatic urinary occult blood on mass examination. SUBJECTS AND METHODS: The subjects were 200 individuals over 40 years old (44 men with a median age of 53.4 years and 156 women with a median age of 57.2 years) who were positive for urinary occult blood on mass examination between January 1993 and December 1994. The subjects were classified into three groups based on the pattern of their RVDC. Group NG showed a nonglomerular pattern, group M showed a mixed pattern, and group G showed a glomerular pattern. The urological examinations performed included DIP, ultrasound of the kidney and urinary bladder and urethrocystoscopy. To investigate the prognosis, a questionnaire was sent to all subjects in September 1999 in which they were asked about the state of their disease during the period since the initial examination. RESULTS: Group G consisted of 192 patients, or almost all of the subjects (96%). There were five patients (2.5%) who had serious urological diseases, including two with bladder cancer, and all were found in Groups NG and M. During the period from initial examination until the prognosis survey (mean of 5.7 year), one patient in group G developed both bladder and ureteral cancer. The CVDC showed a mixed pattern when this patient was discovered. CONCLUSION: RVDC was useful for screening patients who were found to be positive for urinary occult blood on mass examination. When the RVDC shows a non-glomerular or mixed pattern, detailed urological examination including endoscopy is necessary.

Adult↗
PubMed1991

Six years of occult blood screening in an urban public hospital: concepts, methods, and reflections on approaches to reducing avoidable mortality among black Americans.

While early cancer detection is frequently overused in high socioeconomic status communities, opportunities for early detection often are overlooked by practitioners serving lower income and minority populations. Review of our patient records in 1980 revealed that only 13% of patients had a record of a rectal examination, and less than 1% had either proctoscopy or fecal occult blood testing. Our program has made a dramatic impact on colorectal cancer detection, performing 8192 fecal occult blood tests in the first 5 1/2 years of our program. As with other programs, stage of cancer is greatly influenced by fecal occult blood testing, with 0 modified Dukes' stage D compared to 33% for the hospital registry, and 35% stage A compared to 0 for the registry. Compliance with diagnostic evaluation has been excellent (89.6%). The program has allowed for increased communication between patients and staff. Education about diet and other prevention has been institutionalized. Patients see our nurses as their advocates and openly express their fears and concerns about their health and health care. We began our fecal occult blood testing program at a time when it was considered the "standard of care" although randomized clinical trial proof was, and is, incomplete. This program provides evidence that "standard of care" is feasible in the public sector.

Black or African American↗
PubMed1994

Effects of diet on fecal occult blood testing in healthy dogs.

Six dogs were fed each of nine diets to evaluate the effects of diet on fecal occult blood test results. The diets represented a range of different type (i.e. canned, dry or semi-moist), protein and vegetable constituents, and fiber contents. Each diet was fed twice daily for five consecutive days; fecal samples were collected twice daily on days 4 and 5. An o-tolidine test kit and a guaiac paper test kit for fecal occult blood were used. Two hundred and sixteen fecal samples were analyzed (24 samples/diet). When using the guaiac test the following positive results were obtained from fecal samples from dogs consuming a canned meat- and vegetable-based diet (24/24 samples); a canned meat-based diet (24/24 samples); a dry corn and poultry-based diet (9/24 samples); a dry corn, wheat, and meat meal diet (4/24 samples), a canned poultry-based diet (1/24 sample) and a semi-moist soybean meal-based diet (2/24 samples). A total of 64 samples were positive using the guaiac test. Using the o-tolidine test, no samples were positive. The difference between the number of positive results with each test kit was highly significant (p < 0.001). Results indicate that 1) diet affects the specificity of guaiac test fecal occult blood results in the dog and 2) positive o-tolidine test results were not caused by diets fed in the study.

Animal Feed↗
PubMed2006

Evaluation of the sensitivity and specificity of four laboratory tests for detection of occult blood in cockatiel (Nymphicus hollandicus) excrement.

OBJECTIVE: To compare sensitivity and specificity of cytologic examination and 3 chromogen tests for detection of occult blood in cockatiel (Nymphicus hollandicus) excrement. ANIMALS: 20 adult cockatiels. PROCEDURES: Pooled blood from birds was divided into whole blood and lysate aliquots. Excrement was mixed with each aliquot in vitro to yield 6 hemoglobin (Hb) concentrations (range, 0.375 to 12.0 mg of Hb/g of excrement). For the in vivo portion of the study, birds were serially gavaged with each aliquot separately at 5 doses of Hb (range, 2.5 to 40 mg/kg). Three chromogen tests and cytologic examination were used to test excrement samples for occult blood. Sensitivity, specificity, and observer agreement were calculated. RESULTS: In vitro specificity ranged from 85%to 100% for the 3 chromogen tests and was 100% for cytologic examination. Sensitivity was 0% to 35% for cytologic examination and 100% for the 3 chromogen tests on samples containing >or= 1.5 mg of Hb/g of excrement. In vivo specificity was 100%, 90%, 65%, and 45% for cytologic examination and the 3 chromogen tests, respectively. Sensitivity was 0% to 5% for cytologic examination and >or= 75% for all 3 chromogen tests after birds received doses of Hb >or= 20 mg/kg. Observer agreement was lowest for cytologic examination. CONCLUSIONS AND CLINICAL RELEVANCE: Chromogen tests were more useful than cytologic examination for detection of occult blood in cockatiel excrement. The best combination of sensitivity, specificity, and observer agreement was obtained by use of a chromogen test.

Animals↗
PubMedDate not supplied

Colonoscopic evaluation of immunochemical fecal occult blood test for detection of colorectal neoplasia.

BACKGROUND/AIMS: This study was carried out to assess the validity of three testing methods of immunochemical occult blood according to the number of collection times as a means for colorectal cancer screening. METHODOLOGY: Four thousand six hundred and eleven asymptomatic individuals, who received both an immunochemical occult blood test with a three-day method and colonoscopy during a medical checkup, served as subjects for this study. For evaluation of the desirable number of sampling times, we used the results of the first day for the 1-day method, the results of the first and second days for the 2-day method, and the results of three-consecutive days for the 3-day method. Sensitivities and specificities of these three testing methods were evaluated. RESULTS: Sensitivities and specificities for colorectal cancer were calculated to be 56% and 97% for the 1-day method, 83% and 96% for the 2-day method, and 89% and 94% for the 3-day method, respectively, showing a significant difference in sensitivity between the 1-day and the 2-day methods, as well as the 3-day method (p < 0.01), and in specificity between the 1-day as well as the 2-day and 3-day methods (p < 0.05). CONCLUSIONS: These findings indicate that the immunochemical fecal occult blood test is useful for the diagnosis of colorectal cancer, and that 2-day testing is recommended as a means of screening for colorectal cancer.

Adenoma↗
PubMed1999

Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood.

BACKGROUND: In 1993, a randomized controlled trial in Minnesota showed, after 13 years of follow-up, that annual fecal occult blood testing was effective in reducing colorectal cancer mortality by at least 33%. Biennial screening (i.e., every 2 years) resulted in only a 6% mortality reduction. Two European trials (in England and in Denmark) subsequently showed statistically significant 15% and 18% mortality reductions with biennial screening. Herein, we provide updated results-through 18 years of follow-up--from the Minnesota trial that address the apparent inconsistent findings among the trials regarding biennial screening. METHODS: From 1976 through 1977, a total of 46551 study subjects, aged 50-80 years, were recruited and randomly assigned to an annual screen, a biennial screen, or a control group. A screen consisted of six guaiac-impregnated fecal occult blood tests (Hemoccult) prepared in pairs from each of three consecutive fecal samples. Participants with at least one of the six tests that were positive were invited for a diagnostic examination that included colonoscopy. All participants were followed annually to ascertain incident colorectal cancers and deaths. RESULTS: The numbers of deaths from all causes were similar among the three study groups. Cumulative 18-year colorectal cancer mortality was 33% lower in the annual group than in the control group (rate ratio, 0.67; 95% confidence interval [CI] = 0.51-0.83). The biennial group had a 21% lower colorectal cancer mortality rate than the control group (rate ratio, 0.79; 95% CI = 0.62-0.97). A marked reduction was also noted in the incidence of Dukes' stage D cancers in both screened groups in comparison with the control group. CONCLUSION: The results from this study, together with the other two published randomized trials of fecal occult blood screening, are consistent in demonstrating a substantial, statistically significant reduction in colorectal cancer mortality from biennial screening.

Aged↗
PubMed2003

Fecal occult blood testing in a general medical clinic: comparison between guaiac-based and immunochemical-based tests.

PURPOSE: Guaiac-based fecal occult blood tests are limited by poor patient compliance, and low sensitivity, specificity, and positive predictive value. Newer immunochemical-based tests are designed to improve accuracy and patient compliance. We compared patient compliance and the test characteristics of these two types of tests. METHODS: The laboratory outcomes associated with use of different fecal occult blood tests were examined in a Veterans Affairs-based general medicine clinic that was divided into two firms with similar patient and provider characteristics. Tests were ordered for colorectal cancer screening or for symptom evaluation. Patients were given one of the two tests depending on their firm. The completion and positivity rates, time to test completion, completion of diagnostic follow-up, and positive predictive values were compared. RESULTS: The percentage of returned test cards was similar between the two groups (47% [1369/2964] for guaiac-based tests vs. 48% [1410/2965] for immunochemical-based tests) as was the positivity rate (9.0% [122/1396] and [128/1410] for both groups). In patients with positive tests who underwent further colon evaluation, the proportion with adenomas was similar between groups (59% [38/64] vs. 58% [40/69]). However, 17% (12/69) with a positive immunochemical-based test had an adenoma >1 cm or a colorectal malignancy, versus 30% (19/64) for guaiac-based tests (P = 0.09). CONCLUSION: Overall, immunochemical-based and guaiac-based fecal occult blood tests had comparable performance. However, although immunochemical-based testing is reported to be easier for patients than guaiac-based testing, we found that patients were no more likely to return cards for analysis. The similar positive predictive value and additional cost of immunochemical-based tests call into question their utility in general practice.

Aged↗
PubMed1995

Reduction in risk of mortality from colorectal cancer by fecal occult blood screening with immunochemical hemagglutination test. A case-control study.

Fecal occult blood testing by immunochemical hemagglutination has been shown to be superior to the Hemoccult test, both in sensitivity and in specificity. The test has been widely used as a tool for population screening in Japan, but there has been no study to evaluate the efficacy of screening using this test. A case-control study to evaluate the screening was conducted in study areas where no previous and no other concomitant colorectal cancer screening had been performed. Case series in the study were 193 cases who died of colorectal cancer. Three controls were selected randomly from the list of individuals who were alive at the time of diagnosis of the corresponding case and had been living in the same area as the case, matched by gender and by age. Odds ratios (OR) of dying of colorectal cancer for those screened within 1, 2 and 3 years of case diagnosis vs. those not screened were 0.40 [95% confidence interval (CI) 0.17-0.92], 0.41 (95% CI 0.20-0.82), and 0.48 (95% CI 0.25-0.92), respectively. OR increased towards 1.0 as the duration during which screening histories were compared was extended, and showed similar tendencies when analyzed by number of years since the most recent screening history. These results suggest that colorectal cancer screening by the immunochemical fecal occult blood test would reduce mortality from colorectal cancer.

Adult↗