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January 27, 1989, Vol 261, No. 4 >
ARTICLE | January 27, 1989

Occult Blood Screening for Colorectal Cancer FREE

Kevin K. Knight, MD, MPH; Jonathan E. Fielding, MD, MPH; Renaldo N. Battista, MD, ScD
[+] Author Affiliations

Reprint requests to Johnson & Johnson Health Management Inc, 2825 Santa Monica Blvd, Santa Monica, Calif 90404 (Dr Fielding).


JAMA. 1989;261(4):586-593. doi:10.1001/jama.1989.03420040124032
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Article
References

GENERAL BACKGROUND  Colorectal cancer has long been the target of efforts aimed at early detection. It is the second most common cancer in the United States, with 140 000 new cases and 60 000 deaths estimated to have occurred in 1987.1 It is uncommon in persons younger than 50 years but its incidence increases sharply thereafter.2 Investigations into the causes of colorectal cancer have not yielded a consensus strategy for prevention. However, early treatment generally is acknowledged to be more beneficial than late treatment. Early detection would thus seem to be a reasonable approach to lowering the toll of this cancer.The American Cancer Society and the National Cancer Institute recommend yearly occult blood testing for all persons older than 50 years of age.3,4 The Canadian Task Force on the Periodic Health Examination has recommended the use of fecal occult blood testing by asymptomatic persons older than

REFERENCES

1 +
Silverberg E, Lubera J:  Cancer statistics, 1987 . CA 1987;;37:2-19.
2 +
Surveillance, Epidemiology and End-Results: Incidence and Mortality Data, 1973-1977 , monograph 57. Bethesda, Md, National Cancer Institute, 1981;, p 72.
3 +
 Guidelines for the cancer-related checkup: Recommendations and rationale . CA 1980;;30:194-240.
4 +
Working Guidelines for Early Detection Approved by the National Cancer Institute Advisory Board , Bethesda, Md, National Cancer Institute, 1987;.
5 +
Canadian Task Force on the Periodic Health Examination:  The periodic health examination . Can Med Assoc J 1979;;121:1193-1247.
6 +
Brodie DR (ed): Screening and Early Detection of Colorectal Cancer , NIH publication 80-2075. Dept of Health, Education, and Welfare, 1979;.
7 +
Simon JB:  Occult blood screening for colorectal carcinoma: A critical review . Gastroenterology 1985;;88:820-837.
8 +
Frank JW:  Occult-blood screening for colorectal carcinoma: The benefits . Am J Prev Med 1985;;1:3-9.
9 +
Frank JW:  Occult-blood screening for colorectal carcinoma: The risks . Am J Prev Med 1985;;1:25-32.
10 +
Frank JW:  Occult-blood screening for colorectal carcinoma: The yield and the costs . Am J Prev Med 1985;;1:18-24.
11 +
Chamberlain J, Day NE, Hakama M, et al:  UICC workshop of the project on evaluation of screening programs for gastrointestinal cancer . Int J Cancer 1986;;37:329-334.
12 +
Morson BC:  Genesis of colorectal cancer . Clin Gastroenterol 1976;;5:505-525.
13 +
Muto T, Bussey HJR, Morson BC:  The evolution of cancer of the colon and rectum . Cancer 1975;;36:2251-2270.
14 +
Lane N, Kaplan H, Pascal RR:  Minute adenomatous and hyperplastic polyps of the colon . Gastroenterology 1971;;60:537-551.
15 +
Arthur JF:  Structure and significance of metaplastic nodules in the rectal mucosa . J Clin Pathol 1968;;21:735.
16 +
Tedesco FJ, Hendrix JC, Pickens CA, et al:  Diminutive polyps: Histopathology, spatial distribution, and clinical significance . Gastrointest Endose 1982;;28:1-5.
17 +
Fenoglio-Preiser CM, Hutter RVP:  Colorectal polyps: Pathologic diagnosis and clinical significance . CA 1985;;35:323-345.
18 +
Sugarbaker PH, Gunderson LL, Wittes RE:  Colorectal cancer , in Devita VT Jr, Hillman S, Rosenberg SA (eds): Cancer Principles and Practice of Oncology , ed 2. Philadelphia, JB Lippincott, 1985;, pp 795-884.
19 +
Morson BC:  The evolution of colorectal carcinoma . Clin Radiol 1984;;35:425-431.
20 +
Rosevelt J, Frankl H:  Colorectal cancer screening by nurse practitioner using 60-cm flexible fiberoptic sigmoidoscope . Dig Dis Sci 1984;; 29:161-163.
21 +
Love RR, Morrissey JF:  Colonoscopy in asymptomatic individuals with a family history of colorectal cancer . Arch Intern Med 1984;;144:2209-2211.
22 +
Demers RY, Demers P, Hoar SK, et al:  Prevalence of colorectal polyps among Michigan pattern and model makers . J Occup Med 1985;;27:809-812.
23 +
Wherry DC:  Screening for colorectal neoplasia in asymptomatic patients using flexible fiberoptic sigmoidoscopy . Dis Colon Rectum 1981;;24:521-522.
24 +
Fenoglio CM, Pascal RR:  Colorectal adenomas and cancer: Pathologic relationships . Cancer 1982;;50:2601-2608.
25 +
Greene FL:  Distribution of colorectal neoplasms: A left to right shift of polyps and cancer . Am Surg 1983;;49:62-65.
26 +
Bat L, Pines A, Ron E, et al:  Colorectal adenomatous polyps and carcinoma in Ashkenazi and non-Ashkenazi Jews in Israel . Cancer 1986;;58:1167-1171.
27 +
Greegor DH:  Diagnosis of large-bowel cancer in the asymptomatic patient . JAMA 1967;;201:943-945.
28 +
Irons GV Jr, Kirsner JB:  Routine chemical tests of the stool for occult blood: An evaluation . Am J Med Sci 1965;;249:247-260.
29 +
Illingworth DG:  Influence of diet on occult blood tests . Gut 1965;;6:595-598.
30 +
Grossman MI, Matsumoto KK, Lichter RJ:  Fecal blood loss produced by oral and intravenous administration of various salicylates . Gastroenterology 1961;;40:383-388.
31 +
Rees WD, Turnberg LA:  Reappraisal of the effects of aspirin on the stomach . Lancet 1980;;2:410-413.
32 +
Lifton LJ, Kreiser J:  False-positive stool occult blood tests caused by iron preparations: A controlled study and review of literature . Gastroenterology 1982;;83:860-863.
33 +
Burton RM, Landreth KS, Barrows GH, et al:  Appearance, properties, and origin of altered human hemoglobin in feces . Lab Invest 1976;;35:3-5.
34 +
Jaffe RM, Kasten B, Young DS, et al:  False-negative stool occult blood tests caused by ingestion of ascorbic acid (vitamin C) . Ann Intern Med 1975;;83:824-826.
35 +
Morris DW, Hansell JR, Ostrow D, et al:  Reliability of chemical tests for fecal occult blood in hospitalized patients . Dig Dis 1976;;21:845-852.
36 +
Herzog P, Holtermuller KH, Preiss J, et al:  Fecal blood loss in patients with colonic polyps: A comparison of measurements with 51 chromium—labeled erythrocytes and with the Hemoccult test . Gastroenterology 1982;;83:957-962.
37 +
Griffith CDM, Turner DJ, Saunders JH:  False negative results of Hemoccult test in colorectal cancer . Br Med J 1981;;283:472.
38 +
Crowley ML, Freeman LD, Mottet MD, et al:  Sensitivity of guaiac-impregnated cards for the detection of colorectal neoplasia . J Clin Gastroenterol 1983;;5:127-130.
39 +
Rosenfield RE, Kochwa S, Kaczera Z, et al:  Nonuniform distribution of occult blood in feces . Am J Clin Pathol 1979;;71:204-209.
40 +
Macrae FA, St John DJB, Caligiore P, et al:  Optimal dietary conditions for hemoccult testing . Gastroenterology 1982;;82:899-903.
41 +
Heinrich HC, Icagic F:  Comparative studies on the "in vivo" sensitivity of four commercial pseudoperoxidase-based faecal occult blood tests in relation to actual blood losses as calculated from measured whole body 59Fe-elimination rates . Klin Wochenschr 1980;;58:1283-1297.
42 +
Stroehlein JR, Fairbanks VF, McGill DB, et al:  Hemoccult detection of fecal occult blood quantitated by radioassay . Dig Dis 1976;;21:841-844.
43 +
Gnauck R, Macrae FA, Fleisher M:  How to perform the fecal occult blood test . CA 1984;;34:134-147.
44 +
Norfleet RG:  One thousand three hundred mg of aspirin daily does not cause positive fecal Hemoccult tests . J Clin Gastroenterol 1983;;5:123-125.
45 +
Neuhauser D, Lewicki AM:  What do we gain from the sixth stool guaiac? N Engl J Med 1975;; 293:226-228.
46 +
Wells HJ, Pagano JF:  "Hemoccult" (TM) testreversal of false-negative results due to storage , abstracted. Gastroenterology 1977;;72:1148.
47 +
Barrows GH, Burton RM, Jarrett DD, et al:  Immunochemical detection of human blood in feces . Am J Clin Pathol 1978;;69:342-346.
48 +
Songster CL, Barrows GH, Jarrett DD:  Immunochemical detection of fecal occult blood the fecal smear punch-disc test: A new non-invasive screening test for colorectal cancer . Cancer 1980;;45:1099-1102.
49 +
Armitage N, Hardcastle JD, Amar SS, et al:  A comparison of an immunological faecal occult blood test Fecatwin sensitive/FECA EIA with Haemoccult in population screening for colorectal cancer . Br J Cancer 1985;;51:799-804.
50 +
Schwartz S, Dahl J, Ellefson M, et al:  The "Hemo-Quant" test: A specific and quantitative determination of heme (hemoglobin) in feces and other materials . Clin Chem 1983;;29:2061-2067.
51 +
Ahlquist DA, McGill DB, Schwartz S, et al:  Hemo-Quant, a new quantative assay for fecal hemoglobin: Comparison with Hemoccult . Ann Intern Med 1984;;101:297-302.
52 +
Alquist DA, McGill DB, Schwartz S, et al:  Fecal blood levels in health and disease: A study using Hemo-Quant . N Engl J Med 1985;;312:1422-1428.
53 +
Peterson WL, Fordtran JS:  Quantitating the occult . N Engl J Med 1985;;312:1448-1449.
54 +
Eddy DM, Nugent FW, Eddy JF, et al:  Screening for colorectal cancer in a high risk population: Results of a mathematical model . Gastroenterology 1987;;92:682-692.
55 +
Cole P, Morrison AS:  Basic issues in population screening for cancer . JNCI 1980;;64:1263-1272.
56 +
Hughes LE:  The incidence of benign and malignant neoplasms of the colon and rectum: A post mortem study . Aust NZ J Surg 1968;;38:30-35.
57 +
Rickert RR, Auerback O, Garfinke L, et al:  Adenomatous lesions of the large bowel: An autopsy survey . Cancer 1979;;43:1847-1857.
58 +
Williams AR, Balasooriy BAW, Day DW:  Polyps and cancer of the large bowel: A necropsy study in Liverpool . Gut 1982;;23:835-842.
59 +
Hastings JB:  Mass screening for colorectal cancer . Am J Surg 1974;;127:228-233.
60 +
Miller SR, Knight AR:  The early detection of colorectal cancer . Cancer 1977;;40:945-949.
61 +
Goodman MJ:  Mass screening for colorectal cancer: A negative report . JAMA 1977;;237:2380.
62 +
Helfrich GB, Petrucci P, Webb H:  Mass screening for colorectal cancer . JAMA 1977;;237:2380.
63 +
Fruhmorgen P, Demling L:  Early detection of colorectal carcinoma with a modified guaiac test: A screening examination in 6000 humans . Acta Gastroenterol Belg 1978;;41:682-687.
64 +
Heeb MA, Ahlvin RC:  Screening for colorectal carcinoma in a rural area . Surgery 1978;;83:540-541.
65 +
Elwood TW, Erickson A, Lieberman S:  Comparative educational approaches to screening for colorectal cancer . Am J Public Health 1978;;68:135-138.
66 +
Winchester DP, Shull JH, Scanlon EF, et al:  A mass screening program for colorectal cancer using chemical testing for occult blood in the stool . Cancer 1980;;45:2955-2958.
67 +
Kurnick JE, Walley LB, Jacob HH, et al:  Colorectal cancer detection in a community hospital screening program . JAMA 1980;;243:2056-2057.
68 +
Schwartz FW, Holstein H, Brecht JG:  Preliminary report of fecal occult blood testing in Germany , in Winawer SJ, Schottenfeld D, Sherlock P (eds): Colorectal Cancer: Prevention, Epidemiology, and Screening . New York, Raven Press, 1980;, pp 267-270.
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Larkin KK:  Mass screening in colorectal cancer . Aust N Z J Surg 1980;;50:467-469.
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Chambers KJ, Morgan BP:  Colorectal cancer and Hemoccult . Aust N Z JSurg 1980;;50:464-467.
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Stuart M, Killingback MJ, Sakker S, et al:  Hemoccult II test: Routine screening procedure for colorectal neoplasm? Med J Aust 1981;;1:629-631.
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Farrands PA, Griffiths RL, Britton DC:  The Frome experiment: Value of screening for colorectal cancer . Lancet 1981;;1:1231-1232.
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Million R, Howarth J, Turnberg E, et al:  Faecal occult blood testing for colorectal cancer in general practice . Practitioner 1982;;226:659-663.
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Sontag SJ, Durczak C, Aranha GV, et al:  Fecal occult blood screening for colorectal cancer in a Veterans Administration hospital . Am J Surg 1983;;145:89-93.
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Siba S:  Experience with Haemoccult screening in Hungary: A multicenter trial . Hepatogastroenterol 1983;;30:27-29.
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Habba SF, Doyle JS:  Colorectal cancer screening of asymptomatic patients in Ireland . Ir J Med Sci 1983;;152:121-124.
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Hoffman A, Young Q, Bright-Asare P, et al:  Early detection of bowel cancer at an urban public hospital: Demonstration project . CA 1983;;33:344-358.
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Cummings KM, Michalek A, Mettlin C, et al:  Screening for colorectal cancer using the Hemoccult II stool guaiac slide test . Cancer 1984;;53:2201-2205.
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Winawer SJ, Andrews M, Flehinger B, et al:  Progress report on controlled trial of fecal occult blood testing for the detection of colorectal neoplasia . Cancer 1980;;45:2959-2964.
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Gilbertsen VA, Church TR, Grewe FJ:  The design of a study to assess occult-blood screening for colon cancer . J Chronic Dis 1980;;33:107-114.
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Gilbertsen VA, McHugh RB, Schuman LM, et al:  The earlier detection of colorectal cancers: A preliminary report of the results of the occult blood study . Cancer 1980;;45:2899-2901.
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Gilbertsen V:  Colon cancer screening: The Minnesota experience . Gastrointest Endosc 1980;; 26:31s-32s.
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Hardcastle JD, Armitage NC, Chamberlain J, et al:  Fecal occult blood screening for colorectal cancer in the general population: Results of a controlled trial . Cancer 1986;;58:397-403.
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Macrae FA, Tan KG, Williams CB:  Toward safer colonoscopy: A report on the complications of 5000 diagnostic or therapeutic colonoscopies . Gut 1983;;24:376-383.
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Doran J, Hardcastle JD:  Bleeding patterns in colorectal cancer: The effect of aspirin and the implications for faecal occult blood testing . Br J Surg 1982;;69:711-713.
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Macrae FA, St John DJB:  Relationship between patterns of bleeding and Hemoccult sensitivity in patients with colorectal cancers or adenomas . Gastroenterology 1982;;82:891-898.
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Ribet A, Frexinos J, Escourrou J, et al:  Occult blood tests and colorectal tumours . Lancet 1980;;1:417.
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Applegate WB, Spector MH:  Colorectal cancer screening . J Community Health 1981;;7:138-151.
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Gnauk R:  Screening tests nack Darmkrebserneuter Vergleich von Haemoccult mit hemoFEC und Ruckblick auf 9 Jahre Klinische Erfahorung mit Haemoccult . Z Gastroenterol 1982;;20:84-92.
90 +
Demers RY, Stawick LE, Demers P:  Relative sensitivity of the fecal occult blood test and flexible sigmoidoscopy in detecting polyps . Prev Med 1985;;14:55-62.
91 +
Macklin MT:  Inheritance of cancer of the stomach and large intestine in man . JNCI 1960;;24:551-571.
92 +
Lovet E:  Family studies in cancer of the colon and rectum . Br J Surg 1976;;63:13-18.
93 +
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94 +
Third National Cancer Survey: Hospitalization and Payments to Hospitals . US Dept of Health, Education, and Welfare, 1976;.
95 +
Kristein MM:  The economics of screening for colorectal cancer . Soc Sci Med 1980;;14C:275-284.
96 +
 Survey of physicians' attitudes and practices in early cancer detection . CA 1984;;35:197-213.
97 +
Gilson BS, Michnich ME, Thompson RS, et al: Physician Effectiveness in Preventive Care: Final Report . National Center for Health Services Research, US Dept of Health and Human Services, 1987;.
98 +
Blalock SJ, De Vellis BM, Sandler RS:  Participation in fecal occult blood screening: A critical review . Prev Med 1987;;16:9-18.
99 +
Selby JV, Friedman GD, Collen MF:  Sigmoidoscopy and mortality from colorectal cancer: The Kaiser-Permanente Multiphasic Evaluation Study . J Clin Epidemiol 1988;;41:427-434.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Silverberg E, Lubera J:  Cancer statistics, 1987 . CA 1987;;37:2-19.
2 +
Surveillance, Epidemiology and End-Results: Incidence and Mortality Data, 1973-1977 , monograph 57. Bethesda, Md, National Cancer Institute, 1981;, p 72.
3 +
 Guidelines for the cancer-related checkup: Recommendations and rationale . CA 1980;;30:194-240.
4 +
Working Guidelines for Early Detection Approved by the National Cancer Institute Advisory Board , Bethesda, Md, National Cancer Institute, 1987;.
5 +
Canadian Task Force on the Periodic Health Examination:  The periodic health examination . Can Med Assoc J 1979;;121:1193-1247.
6 +
Brodie DR (ed): Screening and Early Detection of Colorectal Cancer , NIH publication 80-2075. Dept of Health, Education, and Welfare, 1979;.
7 +
Simon JB:  Occult blood screening for colorectal carcinoma: A critical review . Gastroenterology 1985;;88:820-837.
8 +
Frank JW:  Occult-blood screening for colorectal carcinoma: The benefits . Am J Prev Med 1985;;1:3-9.
9 +
Frank JW:  Occult-blood screening for colorectal carcinoma: The risks . Am J Prev Med 1985;;1:25-32.
10 +
Frank JW:  Occult-blood screening for colorectal carcinoma: The yield and the costs . Am J Prev Med 1985;;1:18-24.
11 +
Chamberlain J, Day NE, Hakama M, et al:  UICC workshop of the project on evaluation of screening programs for gastrointestinal cancer . Int J Cancer 1986;;37:329-334.
12 +
Morson BC:  Genesis of colorectal cancer . Clin Gastroenterol 1976;;5:505-525.
13 +
Muto T, Bussey HJR, Morson BC:  The evolution of cancer of the colon and rectum . Cancer 1975;;36:2251-2270.
14 +
Lane N, Kaplan H, Pascal RR:  Minute adenomatous and hyperplastic polyps of the colon . Gastroenterology 1971;;60:537-551.
15 +
Arthur JF:  Structure and significance of metaplastic nodules in the rectal mucosa . J Clin Pathol 1968;;21:735.
16 +
Tedesco FJ, Hendrix JC, Pickens CA, et al:  Diminutive polyps: Histopathology, spatial distribution, and clinical significance . Gastrointest Endose 1982;;28:1-5.
17 +
Fenoglio-Preiser CM, Hutter RVP:  Colorectal polyps: Pathologic diagnosis and clinical significance . CA 1985;;35:323-345.
18 +
Sugarbaker PH, Gunderson LL, Wittes RE:  Colorectal cancer , in Devita VT Jr, Hillman S, Rosenberg SA (eds): Cancer Principles and Practice of Oncology , ed 2. Philadelphia, JB Lippincott, 1985;, pp 795-884.
19 +
Morson BC:  The evolution of colorectal carcinoma . Clin Radiol 1984;;35:425-431.
20 +
Rosevelt J, Frankl H:  Colorectal cancer screening by nurse practitioner using 60-cm flexible fiberoptic sigmoidoscope . Dig Dis Sci 1984;; 29:161-163.
21 +
Love RR, Morrissey JF:  Colonoscopy in asymptomatic individuals with a family history of colorectal cancer . Arch Intern Med 1984;;144:2209-2211.
22 +
Demers RY, Demers P, Hoar SK, et al:  Prevalence of colorectal polyps among Michigan pattern and model makers . J Occup Med 1985;;27:809-812.
23 +
Wherry DC:  Screening for colorectal neoplasia in asymptomatic patients using flexible fiberoptic sigmoidoscopy . Dis Colon Rectum 1981;;24:521-522.
24 +
Fenoglio CM, Pascal RR:  Colorectal adenomas and cancer: Pathologic relationships . Cancer 1982;;50:2601-2608.
25 +
Greene FL:  Distribution of colorectal neoplasms: A left to right shift of polyps and cancer . Am Surg 1983;;49:62-65.
26 +
Bat L, Pines A, Ron E, et al:  Colorectal adenomatous polyps and carcinoma in Ashkenazi and non-Ashkenazi Jews in Israel . Cancer 1986;;58:1167-1171.
27 +
Greegor DH:  Diagnosis of large-bowel cancer in the asymptomatic patient . JAMA 1967;;201:943-945.
28 +
Irons GV Jr, Kirsner JB:  Routine chemical tests of the stool for occult blood: An evaluation . Am J Med Sci 1965;;249:247-260.
29 +
Illingworth DG:  Influence of diet on occult blood tests . Gut 1965;;6:595-598.
30 +
Grossman MI, Matsumoto KK, Lichter RJ:  Fecal blood loss produced by oral and intravenous administration of various salicylates . Gastroenterology 1961;;40:383-388.
31 +
Rees WD, Turnberg LA:  Reappraisal of the effects of aspirin on the stomach . Lancet 1980;;2:410-413.
32 +
Lifton LJ, Kreiser J:  False-positive stool occult blood tests caused by iron preparations: A controlled study and review of literature . Gastroenterology 1982;;83:860-863.
33 +
Burton RM, Landreth KS, Barrows GH, et al:  Appearance, properties, and origin of altered human hemoglobin in feces . Lab Invest 1976;;35:3-5.
34 +
Jaffe RM, Kasten B, Young DS, et al:  False-negative stool occult blood tests caused by ingestion of ascorbic acid (vitamin C) . Ann Intern Med 1975;;83:824-826.
35 +
Morris DW, Hansell JR, Ostrow D, et al:  Reliability of chemical tests for fecal occult blood in hospitalized patients . Dig Dis 1976;;21:845-852.
36 +
Herzog P, Holtermuller KH, Preiss J, et al:  Fecal blood loss in patients with colonic polyps: A comparison of measurements with 51 chromium—labeled erythrocytes and with the Hemoccult test . Gastroenterology 1982;;83:957-962.
37 +
Griffith CDM, Turner DJ, Saunders JH:  False negative results of Hemoccult test in colorectal cancer . Br Med J 1981;;283:472.
38 +
Crowley ML, Freeman LD, Mottet MD, et al:  Sensitivity of guaiac-impregnated cards for the detection of colorectal neoplasia . J Clin Gastroenterol 1983;;5:127-130.
39 +
Rosenfield RE, Kochwa S, Kaczera Z, et al:  Nonuniform distribution of occult blood in feces . Am J Clin Pathol 1979;;71:204-209.
40 +
Macrae FA, St John DJB, Caligiore P, et al:  Optimal dietary conditions for hemoccult testing . Gastroenterology 1982;;82:899-903.
41 +
Heinrich HC, Icagic F:  Comparative studies on the "in vivo" sensitivity of four commercial pseudoperoxidase-based faecal occult blood tests in relation to actual blood losses as calculated from measured whole body 59Fe-elimination rates . Klin Wochenschr 1980;;58:1283-1297.
42 +
Stroehlein JR, Fairbanks VF, McGill DB, et al:  Hemoccult detection of fecal occult blood quantitated by radioassay . Dig Dis 1976;;21:841-844.
43 +
Gnauck R, Macrae FA, Fleisher M:  How to perform the fecal occult blood test . CA 1984;;34:134-147.
44 +
Norfleet RG:  One thousand three hundred mg of aspirin daily does not cause positive fecal Hemoccult tests . J Clin Gastroenterol 1983;;5:123-125.
45 +
Neuhauser D, Lewicki AM:  What do we gain from the sixth stool guaiac? N Engl J Med 1975;; 293:226-228.
46 +
Wells HJ, Pagano JF:  "Hemoccult" (TM) testreversal of false-negative results due to storage , abstracted. Gastroenterology 1977;;72:1148.
47 +
Barrows GH, Burton RM, Jarrett DD, et al:  Immunochemical detection of human blood in feces . Am J Clin Pathol 1978;;69:342-346.
48 +
Songster CL, Barrows GH, Jarrett DD:  Immunochemical detection of fecal occult blood the fecal smear punch-disc test: A new non-invasive screening test for colorectal cancer . Cancer 1980;;45:1099-1102.
49 +
Armitage N, Hardcastle JD, Amar SS, et al:  A comparison of an immunological faecal occult blood test Fecatwin sensitive/FECA EIA with Haemoccult in population screening for colorectal cancer . Br J Cancer 1985;;51:799-804.
50 +
Schwartz S, Dahl J, Ellefson M, et al:  The "Hemo-Quant" test: A specific and quantitative determination of heme (hemoglobin) in feces and other materials . Clin Chem 1983;;29:2061-2067.
51 +
Ahlquist DA, McGill DB, Schwartz S, et al:  Hemo-Quant, a new quantative assay for fecal hemoglobin: Comparison with Hemoccult . Ann Intern Med 1984;;101:297-302.
52 +
Alquist DA, McGill DB, Schwartz S, et al:  Fecal blood levels in health and disease: A study using Hemo-Quant . N Engl J Med 1985;;312:1422-1428.
53 +
Peterson WL, Fordtran JS:  Quantitating the occult . N Engl J Med 1985;;312:1448-1449.
54 +
Eddy DM, Nugent FW, Eddy JF, et al:  Screening for colorectal cancer in a high risk population: Results of a mathematical model . Gastroenterology 1987;;92:682-692.
55 +
Cole P, Morrison AS:  Basic issues in population screening for cancer . JNCI 1980;;64:1263-1272.
56 +
Hughes LE:  The incidence of benign and malignant neoplasms of the colon and rectum: A post mortem study . Aust NZ J Surg 1968;;38:30-35.
57 +
Rickert RR, Auerback O, Garfinke L, et al:  Adenomatous lesions of the large bowel: An autopsy survey . Cancer 1979;;43:1847-1857.
58 +
Williams AR, Balasooriy BAW, Day DW:  Polyps and cancer of the large bowel: A necropsy study in Liverpool . Gut 1982;;23:835-842.
59 +
Hastings JB:  Mass screening for colorectal cancer . Am J Surg 1974;;127:228-233.
60 +
Miller SR, Knight AR:  The early detection of colorectal cancer . Cancer 1977;;40:945-949.
61 +
Goodman MJ:  Mass screening for colorectal cancer: A negative report . JAMA 1977;;237:2380.
62 +
Helfrich GB, Petrucci P, Webb H:  Mass screening for colorectal cancer . JAMA 1977;;237:2380.
63 +
Fruhmorgen P, Demling L:  Early detection of colorectal carcinoma with a modified guaiac test: A screening examination in 6000 humans . Acta Gastroenterol Belg 1978;;41:682-687.
64 +
Heeb MA, Ahlvin RC:  Screening for colorectal carcinoma in a rural area . Surgery 1978;;83:540-541.
65 +
Elwood TW, Erickson A, Lieberman S:  Comparative educational approaches to screening for colorectal cancer . Am J Public Health 1978;;68:135-138.
66 +
Winchester DP, Shull JH, Scanlon EF, et al:  A mass screening program for colorectal cancer using chemical testing for occult blood in the stool . Cancer 1980;;45:2955-2958.
67 +
Kurnick JE, Walley LB, Jacob HH, et al:  Colorectal cancer detection in a community hospital screening program . JAMA 1980;;243:2056-2057.
68 +
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To understand the clinical management of acute heart failure syndromes.
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Compression-Only CPR: Pushing the Science Forward
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BMJ 2010;341:c5893-c1494.
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