Tagged with “FOBT”

Many Doctors Doing Colorectal Cancer Screening Wrong

FOBT screening saves lives, but only when it is done right.

Three out of four primary care doctors did a fecal occult blood test once during an office visit, a method that is ineffective in finding cancer or preventing death from colorectal cancer. One out of four used the in-office test exclusively.

Less than half of doctors had a system in place to be sure that home tests were completed and returned. Continue reading…

Posted by Kate Murphy on May 11th, 2010
Posted in: Research & Treatment News | 1 Comment »
Tags: colorectal cancer prognosis, FIT, FOBT

More Choices Increase Colorectal Cancer Screening Use

When people were offered a personal choice of either FOBT or colonoscopy screening by their primary care provider, more actually completed the test they chose than if only one option was offered.

In a study of 1,000 ethnically and racially diverse people, the lowest percentage had a colonoscopy when that was the only test offered. More completed fecal occult blood testing if it was the single choice. Overall 65 percent of the 1,000 patients studied were screened after their doctor recommended testing. Continue reading…

Posted by Kate Murphy on May 8th, 2010
Posted in: Research & Treatment News | No Comments »
Tags: colonoscopy, colorectal cancer screening, FOBT

Experts Recommend Changes for Colorectal Screening Access and Quality

The first priority of an expert panel looking at increasing the number of people being screened for colorectal cancer was to “Eliminate financial barriers to colorectal cancer screening and appropriate follow up.”

Meeting for two days in Washington in February, a National Institutes of Health State-of-the-Science conference considered what is known– and not known– about why people choose or avoid screening, how to improve screening quality, and what the healthcare capacity is to deliver colorectal cancer screening to the US population.

At the end of the meeting, the panel released a consensus statement with their recommendations for enhancing the use and quality of colorectal cancer screening. Continue reading…

Posted by Kate Murphy on February 24th, 2010
Posted in: Research & Treatment News | No Comments »
Tags: colonoscopy, colorectal cancer screening, FOBT

Fecal Occult Blood Tests

Some polyps and cancers in the intestinal tract bleed at times. Testing for hidden (occult) blood in the stool is an inexpensive and noninvasive way to identify them.

Unfortunately, FOBT or fecal occult blood testing does not find those polyps or cancers that are not bleeding. Depending on the sensitivity of the test, it may miss a fair percentage of cancers and most polyps. And the test may be falsely positive because of other conditions that cause intestinal bleeding, requiring unnecessary colonoscopy follow-up.

The latest 2007 Joint Guidelines for Screening recommend fecal occult blood testing as tests that primarily detect cancer.

However, FOBT has been shown in randomized clinical trials to reduce deaths from colorectal cancer by as much as one-third and is an important part of public health screening strategies.

All positive fecal occult blood tests need to be followed-up with a full colonoscopy to look for polyps or cancer.

There are two approaches to FOBT. The older guaiac-based test (gFOBT) measures one part of the hemoglobin molecule. A newer fecal immunochemical test (FIT) measures a different part. Globin, a protein measured by FIT, is only present in when bleeding occurs in the colon or rectum, eliminating false positives from stomach ulcers and bleeding in the the upper digestive tract or meat eaten before the test.

FOBTs are take-home test kits that are completed by patients. It is important that the tests be done accurately, including restricting certain drugs and foods before some tests and taking enough samples. Accuracy improves with the full number of samples and when the test is done every year.

Guaiac FOBT

Dietary and drug restrictions: When you use the guaiac-based FOBT such as Hemoccult®, it is important to avoid non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen, or more than one aspirin a day for seven days before testing. In addition red meat (beef, lamb, and liver) and vitamin C supplements, citrus fruits, and juices should be avoided for three days prior to the test.

Two small samples of three different bowel movements are smeared onto small paper squares. The kit is then returned to the doctor or mailed to a medical laboratory.

FIT

Fecal immunochemical tests (FIT) such as Hemoccult® ICT or InSure® have no drug or dietary restrictions, but it is important to avoid testing during the menstrual period or when there is rectal bleeding or bleeding from the urinary tract.

Samples are collected from bowel movements over two or three consecutive days. Some tests use a stick to collect stool, others use a small brush. None require actually touching the bowel movement.

Digital Rectal Exam

A single test done during a digital rectal exam in a doctor’s office is not sufficient for screening. The United States Preventive Services Task Force says,

Digital Rectal Examination/Office FOBT

There is little evidence to determine the effectiveness of either digital rectal examination or a single office FOBT using a stool sample obtained on DRE. Fewer than 10 percent of colorectal cancers arise within reach of the examining finger, and some of these lesions will already be symptomatic. The sensitivity of a single office FOBT is likely to be substantially lower than that of screening protocols involving multiple test cards: in one study the first test card would have missed 42 percent of cancers detected by screening. Samples collected by DRE may be affected by other limitations, including inadequate amount of stool or trauma from the exam.

Patient Instructions for Some FOBT and FIT screening tests.

Links to instructions are provided for preliminary information for you only. The most current instructions will be included with your test kit. Your doctor may suggest a different brand of test.

Hemoccult ® SENSA

Hemoccult ® ICT

InSure®

Posted by Kate Murphy on February 29th, 2008
Posted in: | Comments Off
Tags: FOBT, screening

Screening Methods

Comparing Screening Methods for Average Risk Patients
Tests that Detect Adenomatous Polyps and Cancer
Colonoscopy	Every 10 years	Most sensitive test for small and large polyps and cancers. Examines the entire colon, polyps can be removed and biopsied during the procedure.	Expensive, requires complete bowel cleansing. Normally uses sedation and requires someone to accompany patient, Rare instances of bowel perforation and bleeding. May not be covered by insurance.
Double-contrast barium enema	Every 5 years	Visualizes the entire colon, can detect most cancers, and the majority of large polyps. Helps patients who cannot complete a colonoscopy or where colonoscopy is not medically appropriate. Less expensive.	Requires complete bowel preparation. May be uncomfortable. An experienced radiologist is critical to quality exam. Colonoscopy is still required to biopsy lesions or removed polyps.
CT-colonography (virtual colonoscopy)	Every 5 years	Does not require sedation. No recovery time, patients can drive home or return to work. Finds cancer and large polyps at the same rate as colonoscopy. May find problems outside the colon as well.	Requires complete bowel preparation. Colonoscopy is required to biopsy and remove polyps. Technology and radiologist training are growing but not complete. May not detect non-polypoid colorectal neoplasms. May not be covered by insurance. False-positive problems identified outside the colon may require unnecessary follow-up tests.
Flexible sigmoidoscopy	Every 5 years	Can be done by primary care physician or trained nurse practitioner. Does not require sedation	Will miss polyps or cancers in the right colon beyond the reach of the scope. If polyps are found, colonoscopy and addition bowel preparation are required. Can be uncomfortable.
Tests that Primarily Detect Cancer
gFOBT: Guaiac-based stool test	Every year	Inexpensive, is done privately at home, can be offered to many people through community programs, including those without primary care or insurance.	Not very sensitive to polyps, will miss some cancers. Needs to be done correctly over three days. Requires diet and drug restrictions. Patients must handle stool. Has a high false positive rate that requires follow-up colonoscopy for about 1 in 3 tests.
FIT: Immunochemical stool test	Every year	Has no diet or drug restrictions prior to the test. Limits blood detected to colon and rectum . Is more sensitive than guaiac-based tests for cancer. May be simpler for patients to do.	Will miss some cancers and most advanced polyps. More expensive than gFOBT. All positive tests require colonoscopy follow-up.
Stool DNA test	Not yet known	Done at home privately. Not necessary to handle stool. Collection kit shipped directly to patient. No special diet prep required.	May not find all cancers or large polyps. Requires prompt, ice-pack shipment to special labs. Significantly more expensive than gFOBT or FIT. Colonoscopy follow-up necessary for positive test.