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One-Time Screening for Colorectal Cancer with Combined Fecal Occult-Blood Testing and Examination of the Distal Colon
Open accessAbstract
BACKGROUND: Fecal occult-blood testing and sigmoidoscopy have been recommended for screening for colorectal cancer, but the sensitivity of such combined testing for detecting neoplasia is uncertain. At 13 Veterans Affairs medical centers, we performed colonoscopy to determine the prevalence of neoplasia and the sensitivity of one-time screening with a fecal occult-blood test plus sigmoidoscopy. METHODS: Asymptomatic subjects (age range, 50 to 75 years) provided stool specimens on cards from three consecutive days for fecal occult-blood testing, which were rehydrated for interpretation. They then underwent colonoscopy. Sigmoidoscopy was defined in this study as examination of the rectum and sigmoid colon during colonoscopy, and sensitivity was estimated by determining how many patients with advanced neoplasia had an adenoma in the rectum or sigmoid colon. Advanced colonic neoplasia was defined as an adenoma 10 mm or more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. Classification of subjects according to the findings was based on the most advanced lesion. RESULTS: A total of 2885 subjects returned the three specimen cards for fecal occult-blood testing and underwent a complete colonoscopic examination. A total of 23.9 percent of subjects with advanced neoplasia had a positive test for fecal occult blood. As compared with subjects who had a negative test for fecal occult blood, the relative risk of advanced neoplasia in subjects who had a positive test was 3.47 (95 percent confidence interval, 2.76 to 4.35). Sigmoidoscopy identified 70.3 percent of all subjects with advanced neoplasia. Combined one-time screening with a fecal occult-blood test and sigmoidoscopy identified 75.8 percent of subjects with advanced neoplasia. CONCLUSIONS: One-time screening with both a fecal occult-blood test with rehydration and sigmoidoscopy fails to detect advanced colonic neoplasia in 24 percent of subjects with the condition.
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Citations
Cited by
WINAWER, S. (2003) · Gastroenterology · doi:10.1053/gast.2003.50044 · Cited by 2,143
Colorectal cancer screening: a global overview of existing programmes
Schreuders, E. H., Ruco, A., Rabeneck, L., Schoen, R. E., Sung, J. J. Y., Young, G. P., & Kuipers, E. J. (2015) · Gut · doi:10.1136/gutjnl-2014-309086 · Cited by 1,328
Association of Colonoscopy and Death From Colorectal Cancer
Baxter, N. N., Goldwasser, M. A., Paszat, L. F., Saskin, R., Urbach, D. R., & Rabeneck, L. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-150-1-200901060-00306 · Cited by 1,254
Fecal DNA versus Fecal Occult Blood for Colorectal-Cancer Screening in an Average-Risk Population
Imperiale, T. F., Ransohoff, D. F., Itzkowitz, S. H., Turnbull, B. A., & Ross, M. E. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa033403 · Cited by 803
Colonoscopy in Colorectal-Cancer Screening for Detection of Advanced Neoplasia
Regula, J., Rupinski, M., Kraszewska, E., Polkowski, M., Pachlewski, J., Orlowska, J., Nowacki, M. P., & Butruk, E. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa054967 · Cited by 788
Metadata
- Authors
- Lieberman, D. A., Harford, W. V., Ahnen, D. J., Provenzale, D., Sontag, S. J., Schnell, T. G., Chejfec, G., Campbell, D. R., Durbin, T. E., Bond, J. H., Nelson, D. B., Ewing, S. L., Triadafilopoulos, G., Ramirez, F. C., Lee, J. G., Collins, J. F., Fennerty, M. B., Johnston, T. K., Corless, C. L., McQuaid, K. R., Garewal, H., Sampliner, R. E., Morales, T. G., Fass, R., Smith, R. E., Maheshwari, Y., & Weiss, D. G.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2001-08-23
- Volume
- 345
- Issue
- 8
- Pages
- 555-560
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1968605703
- Cited by
- 580
- References
- 0
- FWCI
- 19.81
- Type
- journal article
- Language
- en
- Open access
- bronze
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- Lieberman, D. A., Harford, W. V., Ahnen, D. J., Provenzale, D., Sontag, S. J., Schnell, T. G., Chejfec, G., Campbell, D. R., Durbin, T. E., Bond, J. H., Nelson, D. B., Ewing, S. L., Triadafilopoulos, G., Ramirez, F. C., Lee, J. G., Collins, J. F., Fennerty, M. B., Johnston, T. K., Corless, C. L., . . . Weiss, D. G. (2001). One-Time Screening for Colorectal Cancer with Combined Fecal Occult-Blood Testing and Examination of the Distal Colon. New England Journal of Medicine. https://doi.org/10.1056/nejmoa010328
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Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
