Screening for Colorectal Cancer: A Comparison of 3 Fecal Occult Blood Tests

doi:10.1001/archinte.1997.00440300064005

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Vol. 157 No. 9, 12 MAY 1997

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Screening for Colorectal Cancer

A Comparison of 3 Fecal Occult Blood Tests

Bernard Levin, MD; Kenneth Hess, PhD; Constance Johnson

Arch Intern Med. 1997;157(9):970-976.

Abstract

Background
Colorectal cancer is the second leading cause of cancer deathsin the United States. Fecal occult blood testing has becomea standard screening test for large-bowel cancers in the averageasymptomatic population. Performance characteristics of thetest and physician and participant compliance are the 2 majorelements that impact the success of screening and early detection.

Objectives
To evaluate the nonhydrated Hemoccult, rehydrated Hemoccult,and Hemoccult SENSA tests (SmithKline Diagnostics Inc, PaloAlto, Calif) and to assess participant and physician compliance.

Methods
A mass community-based screening study in an urban setting.Kits were distributed by a local pharmacy and at community sites.Diagnostic tests were completed through physicians' officesand clinics. Participants were asymptomatic and aged 50 yearsor older. Those who tested positive were advised to follow upwith a physician.

Results
An overall positivity rate of 16% was reported for the 8293kits that were processed. Rehydrated Hemoccult had a positivityrate of 15%; Hemoccult SENSA, 7%; and nonhydrated Hemoccult,5%. The positive predictive value of nonhydrated Hemoccult was14%; rehydrated Hemoccult, 7%; and Hemoccult SENSA, 11%. Ofthose who tested positive, 59% had a colonoscopy or flexiblesigmoidoscopy and double-contrast barium enema examination onfollow-up. Recommended follow-up was more frequent for thosewho consulted a gastroenterologist.

Conclusions
Rehydrated Hemoccult yielded a higher positivity rate and lowerpositive predictive value than either Hemoccult SENSA or nonhydratedHemoccult. Hemoccult SENSA approached the positive predictivevalue of nonhydrated Hemoccult. Adequacy of follow-up of patientstesting positive for fecal occult blood needs improvement.

Arch Intern Med. 1997;157:970-976

Author Affiliations

From the Division of Cancer Prevention (Dr Levin and Ms Johnson) and the Department of Biomathematics (Dr Hess), The University of Texas M. D. Anderson Cancer Center, Houston.

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