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April 6, 1994, Vol 271, No. 13 >
ARTICLE | April 6, 1994

Fecal Occult Blood Screening for Colorectal Cancer: Title and subTitle BreakIs Mortality Reduced by Chance Selection for Screening Colonoscopy? FREE

Christopher A. Lang, MD; David F. Ransohoff, MD
[+] Author Affiliations

Reprint requests to CB 7105, 5034 Old Clinic Bldg, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7105 (Dr Ransohoff).


JAMA. 1994;271(13):1011-1013. doi:10.1001/jama.1994.03510370063033
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References

Annual fecal occult blood test (FOBT) screening using rehydrated Hemoccult slides has been reported in the Minnesota Colon Cancer Control Study to reduce colorectal cancer mortality by about 33%. However, some of the benefit of FOBT screening may come from "chance" selection of persons for colonoscopic examination because of the high positivity rate of FOBT (about 10%) that may occur for reasons other than a bleeding cancer or polyp. To determine how much this mechanism could account for the benefit of FOBT screening, we used a simple mathematical model to simulate the course of a cohort of screened persons, incorporating published data including those from the Minnesota study. The results suggest that one third to one half of the mortality reduction observed from FOBT screening in the Minnesota study may be attributable to chance selection for colonoscopy. We conclude that annual FOBT screening with rehydration is a haphazard method for selecting persons for colonoscopy.

(JAMA. 1994;271:1011-1013)

REFERENCES

1 +
National Cancer Institute. Working Guidelines for Early Cancer Detection: Rationale and Supporting Evidence to Decrease Mortality . Bethesda, Md: National Cancer Institute; 1987;.
2 +
American Cancer Society. Summary of Current Guidelines for the Cancer-Related Check Up: Recommendations . New York, NY: American Cancer Society; 1989;.
3 +
Knight KK, Fielding JE, Battista RN.  Occult blood screening for colorectal cancer. JAMA . 1989;; 261:586-593.
4 +
American College of Physicians, Clinical Efficacy Assessment Project. Screening for Colorectal Cancer . Philadelphia, Pa: American College of Physicians; 1990;.
5 +
Levin B, Murphy GP.  Revision in American Cancer Society recommendations for the early detection of colorectal cancer. CA Cancer J Clin . 1992;; 42:296-299.
6 +
Clayman CB.  Mass screening for colorectal cancer: are we ready? JAMA . 1989;;261:609.
7 +
Smart CR.  Critique of the early cancer detection guidelines of the US Preventive Services Task Force and of the National Cancer Institute. Mayo Clin Proc . 1990;;65:892-898.
8 +
Ransohoff DF, Lang CA.  Screening for colorectal cancer. N Engl J Med . 1991;;325:37-41.
9 +
Ransohoff DF, Lang CA.  Sigmoidoscopic screening in the 1990s. JAMA . 1993;;269:1278-1281.
10 +
Mandel JS, Bond JH, Church TR, et al.  Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med . 1993;;328:1365-1371.
11 +
 The value of colon cancer tests. New York Times . (May 21) , 1993;:A26. Editorial.
12 +
Winawer SJ.  Colorectal cancer screening comes of age. N Engl J Med . 1993;;328:1416-1417.
13 +
Kronborg O, Fenger C, Sondergaard O, Pedersen KM, Olsen J.  Initial mass screening for colorectal cancer with fecal occult blood test. Scand J Gastroenterol . 1987;;22:677-686.
14 +
KewenterJ, Bjork S, Haglind E, Smith L, Svanvik J, Ahren C.  Screening and rescreening for colorectal cancer: a controlled trial of fecal occult blood testing in 27 700 subjects. Cancer . 1988;;62:645-651.
15 +
Hardcastle JD, Thomas WM, Chamberlain J, et al.  Randomised, controlled trial of fecal occult blood screening for colorectal cancer. Lancet . 1989;;1:1160-1164.
16 +
Winawer SJ, Flehinger BJ, Schottenfeld D, Miller DG.  Screening for colorectal cancer with fecal occult blood testing and sigmoidoscopy. J Natl Cancer Inst . 1993;;85:1311-1318.
17 +
Boland CR. State of the art lecture: reducing colorectal cancer mortality: screening, case findings, and surveillance. Presented at the Plenary Session of American Gastroenterological Association Meeting; May 17, 1993; Boston, Mass.
18 +
Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM.  Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst . 1992;;84:1572-1575.
19 +
Selby JV, Friedman GD, Quesenberry CPJ, Weiss NS.  A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med . 1992;;326:653-657.
20 +
National Center for Health Statistics. Vital Statistics of the United States, 1989: Volume II, Section 6—Life Tables . Washington, DC: Public Health Service; 1992;.
21 +
Miller BA, Ries LAG, Hankey BF, Kosary CL, Edwards BK. Cancer Statistics Review: 1973-1989 . Bethesda, Md: National Cancer Institute; 1992;. National Institutes of Health publication 92-2789.
22 +
Ahlquist DA, Wieand HS, Moertel CG, et al.  Accuracy of fecal occult blood screening for colorectal neoplasia: a prospective study using Hemoccult and HemoQuant tests. JAMA . 1993;;269:1262-1267.
23 +
Ransohoff DF, Feinstein AR.  Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med . 1978;;299:926-930.
24 +
Ransohoff DF, Lang CA, Kuo HS.  Colonoscopic surveillance after polypectomy: considerations of cost-effectiveness. Ann Intern Med . 1991;;114:177-182.

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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 +
National Cancer Institute. Working Guidelines for Early Cancer Detection: Rationale and Supporting Evidence to Decrease Mortality . Bethesda, Md: National Cancer Institute; 1987;.
2 +
American Cancer Society. Summary of Current Guidelines for the Cancer-Related Check Up: Recommendations . New York, NY: American Cancer Society; 1989;.
3 +
Knight KK, Fielding JE, Battista RN.  Occult blood screening for colorectal cancer. JAMA . 1989;; 261:586-593.
4 +
American College of Physicians, Clinical Efficacy Assessment Project. Screening for Colorectal Cancer . Philadelphia, Pa: American College of Physicians; 1990;.
5 +
Levin B, Murphy GP.  Revision in American Cancer Society recommendations for the early detection of colorectal cancer. CA Cancer J Clin . 1992;; 42:296-299.
6 +
Clayman CB.  Mass screening for colorectal cancer: are we ready? JAMA . 1989;;261:609.
7 +
Smart CR.  Critique of the early cancer detection guidelines of the US Preventive Services Task Force and of the National Cancer Institute. Mayo Clin Proc . 1990;;65:892-898.
8 +
Ransohoff DF, Lang CA.  Screening for colorectal cancer. N Engl J Med . 1991;;325:37-41.
9 +
Ransohoff DF, Lang CA.  Sigmoidoscopic screening in the 1990s. JAMA . 1993;;269:1278-1281.
10 +
Mandel JS, Bond JH, Church TR, et al.  Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med . 1993;;328:1365-1371.
11 +
 The value of colon cancer tests. New York Times . (May 21) , 1993;:A26. Editorial.
12 +
Winawer SJ.  Colorectal cancer screening comes of age. N Engl J Med . 1993;;328:1416-1417.
13 +
Kronborg O, Fenger C, Sondergaard O, Pedersen KM, Olsen J.  Initial mass screening for colorectal cancer with fecal occult blood test. Scand J Gastroenterol . 1987;;22:677-686.
14 +
KewenterJ, Bjork S, Haglind E, Smith L, Svanvik J, Ahren C.  Screening and rescreening for colorectal cancer: a controlled trial of fecal occult blood testing in 27 700 subjects. Cancer . 1988;;62:645-651.
15 +
Hardcastle JD, Thomas WM, Chamberlain J, et al.  Randomised, controlled trial of fecal occult blood screening for colorectal cancer. Lancet . 1989;;1:1160-1164.
16 +
Winawer SJ, Flehinger BJ, Schottenfeld D, Miller DG.  Screening for colorectal cancer with fecal occult blood testing and sigmoidoscopy. J Natl Cancer Inst . 1993;;85:1311-1318.
17 +
Boland CR. State of the art lecture: reducing colorectal cancer mortality: screening, case findings, and surveillance. Presented at the Plenary Session of American Gastroenterological Association Meeting; May 17, 1993; Boston, Mass.
18 +
Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM.  Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst . 1992;;84:1572-1575.
19 +
Selby JV, Friedman GD, Quesenberry CPJ, Weiss NS.  A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med . 1992;;326:653-657.
20 +
National Center for Health Statistics. Vital Statistics of the United States, 1989: Volume II, Section 6—Life Tables . Washington, DC: Public Health Service; 1992;.
21 +
Miller BA, Ries LAG, Hankey BF, Kosary CL, Edwards BK. Cancer Statistics Review: 1973-1989 . Bethesda, Md: National Cancer Institute; 1992;. National Institutes of Health publication 92-2789.
22 +
Ahlquist DA, Wieand HS, Moertel CG, et al.  Accuracy of fecal occult blood screening for colorectal neoplasia: a prospective study using Hemoccult and HemoQuant tests. JAMA . 1993;;269:1262-1267.
23 +
Ransohoff DF, Feinstein AR.  Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med . 1978;;299:926-930.
24 +
Ransohoff DF, Lang CA, Kuo HS.  Colonoscopic surveillance after polypectomy: considerations of cost-effectiveness. Ann Intern Med . 1991;;114:177-182.

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