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Offering people a choice for colorectal cancer screening

A study in the latest issue of Gut examines the effect of offering people a choice for colorectal cancer screening.

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Dr Carlo Senore and colleagues from Italy assessed the population coverage and diagnostic yield of offering an immunochemical fecal occult blood test to non-responders to a flexible sigmoidoscopy invitation.

A cohort study conducted in a population-based colorectal cancer screening program.

In this program, eligible men and women aged 58 or 60 are invited, with a personal letter signed by their general practitioner, to undergo an flexible sigmoidoscopy.

Bowel preparation is limited to a single enema self-administered at home.
 
Subjects in whom one distal polyp more than 5 mm or at least one adenoma is detected at flexible sigmoidoscopy are referred for colonoscopy.

19% underwent an immunochemical fecal occult blood test
Gut

The team reported that people who do not respond to the invitation to undergo an flexible sigmoidoscopy are invited to have an immunochemical fecal occult blood test.

Attendance rate and neoplasia yield were analyzed in 4 consecutive birth cohorts.

The research team found that overall participation rate for the flexible sigmoidoscopy invitation was 39% in Verona, and 30% in Turin.

Of the eligible non-responders to the flexible sigmoidoscopy invitation, 19% underwent an immunochemical fecal occult blood test.

As a result, the team reported that the proportion of people undergoing screening by flexible sigmoidoscopy or immunochemical fecal occult blood test was 55% in Verona, and 39% in Turin, with no gender differences in either center.

Immunochemical fecal occult blood test detected 8% of all advanced adenomas, and 20% of all colorectal cancers diagnosed at screening.

Dr Senore's team concludes, "A strategy involving the sequential offer of flexible sigmoidoscopy, and immunochemical fecal occult blood test is a feasible and efficient approach."

"Immunochemical fecal occult blood test in people not attending for flexible sigmoidoscopy increases screening uptake and detection of advanced adenomas and colorectal cancers."

Gut 2013; 62: 735-740 
10 April 2013

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