Current screening methods for Fecal Occult Blood Tests are
often not appropriate
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(HealthNewsDigest.com) – More than 75 percent of primary care physicians in the United States who order or perform the fecal occult blood test (FOBT) as a screening option for colorectal cancer perform an in-office test rather than relying on the home-based test, even though the home-based test is more
accurate, a study by the Centers for Disease Control and Prevention has found.
National guidelines recommend that FOBT testing be done with stool
samples collected at home. Previous studies have shown that the
in-office FOBT, in which a single stool sample is collected by a
physician during a digital rectal examination, is ineffective because it
misses 95 percent of cancers or polyps that may become cancer. The
in-office test is not recommended for colorectal cancer screening.
The study, “Fecal Occult Blood Testing Beliefs and Practices of U.S.
Primary Care Physicians: Serious Deviations from Evidence-Based
Recommendations,” is published online by the Journal of General Internal
Medicine at
http://www.springerlink.com/content/p7q4n4114510574t/fulltext.pdf
“Many primary care physicians continue to use inappropriate FOBT
methods to screen for colorectal cancer, thereby missing the potential
to save lives,” said Marion Nadel, Ph.D., health scientist in CDC’s
Division of Cancer Prevention and Control, and lead author of the study.
“FOBT is an important option for screening, but it must be implemented
correctly. People who choose FOBT for screening should use
high-sensitivity home tests on an annual basis and be sure to follow-up
on any positive result.”
In this new study, researchers analyzed data from the 2006-2007 National
Survey of Primary Care Physicians’ Recommendations and Practices for
Cancer Screening conducted by the National Cancer Institute in
collaboration with CDC and the Agency for Healthcare Research and
Quality. The scientists looked at whether there has been improvement
since 2000, when an earlier study revealed that many primary care
physicians used inappropriate methods to implement FOBT.
The current survey included 1,134 primary care physicians who reported
ordering or performing FOBT at least once per month. The researchers
examined FOBT implementation practices and physicians’ beliefs about and
use of the newer tests, the high-sensitivity guaiac-based FOBT and the
fecal immunochemical tests. In the guaiac-based FOBT, the chemical
guaiac is used to detect blood in the stool. In the fecal immunochemical
tests, antibodies are used to detect blood in the stool.
Of the physicians who reported that they ordered or performed FOBT, 25
percent said they used in-office FOBT exclusively, and about 53 percent
reported using both home and in-office tests. Also, 61 percent of
primary care physicians used the standard guaiac-based FOBT, while use
of the more sensitive guaiac-based test and the fecal immunochemical
tests was significantly lower. The high-sensitivity tests are superior
to the standard guaiac-based FOBT in detecting colorectal cancer and
advanced lesions.
On a positive note, 93 percent of physicians reported using colonoscopy
as a follow-up to a positive FOBT, as recommended in national
guidelines.
Screening is recommended for adults aged 50 years and older. Those with
a family or personal history of colorectal polyps or cancer, or
inflammatory bowel disease, should speak with their physicians about
whether to begin screening at an earlier age. Annual FOBT is one of
several screening options recommended by the U.S. Preventive Services
Task Force and the joint guidelines issued by the American Cancer
Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and
the American College of Radiology. The other recommended screening tests
are flexible sigmoidoscopy (every 5 years) and colonoscopy (every 10
years).
Recent reports show that most primary care physicians recommend FOBT,
either alone or in addition to colonoscopy, to screen for colorectal
cancer. FOBT is preferred by a significant number of adults. Moreover,
it is relatively inexpensive and easily accessible, and often the only
screening test available to people with insufficient insurance coverage
or those who live in areas with limited high-quality endoscopic
services.
The researchers noted that educational efforts are needed to inform
physicians of the recommended practices for screening with FOBT and to
raise awareness of the newer high-sensitivity stool tests. The authors
also encourage efforts to promote the use of provider tracking and
reminder systems to enhance FOBT test completion and follow-up care.
Colorectal cancer is the second leading cause of cancer deaths in the
United States, after lung cancer. In 2006, more than 139,000 new cases
of colorectal cancer were diagnosed and more than 53,000 people died
from this disease. Screening tests can find precancerous polyps so they
can be removed before they have a chance to turn into cancer, thus
preventing the disease. In addition, screening can detect cancers at an
early stage when treatment can be very effective.
CDC’s Colorectal Cancer Control Program funds 26 states and tribal
organizations across the U.S. to increase rates of colorectal cancer
screening among men and women 50 years of age and older through
population-based approaches such as policy and health systems change,
outreach, case management, and selective provision of direct screening
services.
For more information about CDC’s efforts to prevent colorectal cancer,
visit www.cdc.gov/cancer/colorectal and www.cdc.gov/screenforlife.
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