abstract: (FOBT) Fecal occult blood testing instructions and impact on patient adherence

Fecal occult blood testing instructions and impact on patient adherence: Publication year: 2012

Source: Cancer Epidemiology

Introduction
Although the physician's role with patients is crucial in encouraging FOBT screening, the nature and content of physician-patient discussions about FOBT screening is unclear. As part of a larger study, this paper reports on our analyses of physician beliefs about fecal occult blood testing (FOBT) and strategies they employed to enhance patient adherence. The second aim of this paper is to report on the perceptions of individuals at average risk for colorectal cancer (CRC) in regard to their awareness of the FOBT and their responses to physician recommendations about FOBT screening.

Abstract: Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial of Competing Strategies

 Abstract: Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial of Competing Strategies

""We have seen benefit from colon cancer screening with fewer people dying from it," said Dr. Theodore Levin, (MedicineNet quote) a gastroenterologist at the Kaiser Permanente Medical Center in Walnut Creek, Calif., and the author of an accompanying journal editorial. "If we want to raise our screening rates then we need to offer people choices other than colonoscopy."

Adherence to Colorectal Cancer Screening
A Randomized Clinical Trial of Competing Strategies

Background  Despite evidence that several colorectal cancer (CRC) screening strategies can reduce CRC mortality, screening rates remain low. This study aimed to determine whether the approach by which screening is recommended influences adherence.

Methods  We used a cluster randomization design with clinic time block as the unit of randomization. Persons at average risk for development of CRC in a racially/ethnically diverse urban setting were randomized to receive recommendation for screening by fecal occult blood testing (FOBT), colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome was completion of CRC screening within 12 months after enrollment, defined as performance of colonoscopy, or 3 FOBT cards plus colonoscopy for any positive FOBT result. Secondary analyses evaluated sociodemographic factors associated with completion of screening.

Results  A total of 997 participants were enrolled; 58% completed the CRC screening strategy they were assigned or chose. However, participants who were recommended colonoscopy completed screening at a significantly lower rate (38%) than participants who were recommended FOBT (67%) (P < .001) or given a choice between FOBT or colonoscopy (69%) (P < .001). Latinos and Asians (primarily Chinese) completed screening more often than African Americans. Moreover, nonwhite participants adhered more often to FOBT, while white participants adhered more often to colonoscopy.

Conclusions  The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities. Significant variation in overall and strategy-specific adherence exists between racial/ethnic groups; however, this may be a proxy for health beliefs and/or language. These results suggest that patient preferences should be considered when making CRC screening recommendations.

Clinical Oncology News - Stool DNA Test Promising for Colorectal Screening

Clinical Oncology News - Stool DNA Test Promising for Colorectal Screening

"Stool DNA testing is moving the colorectal cancer (CRC) screening field a step closer to eradicating the disease, according to David Ahlquist, MD, Department of Gastroenterology and Hepatology at Mayo Clinic, Rochester, Minn., who helped develop this approach and presented recent findings at the 2012 Gastrointestinal Cancers Symposium.


Stool DNA testing detects tumor-specific DNA alterations in cells that are continually being shed into the stool from precancerous and cancerous lesions. The test is now being developed by Exact Sciences, a molecular diagnostics company in Madison, Wis.

The broad application of stool DNA testing in longitudinal screening programs is to prevent CRC through high precancer detection. In an invited lecture, Dr. Ahlquist said this claim is “not too bold and not hyperbole.” New-generation stool DNA testing, he said, offers “extraordinarily” high detection rates for curable cancers and precancers that are likely to progress. The test detects lesions on both sides of the colon with equal accuracy and reveals flat or serrated polyps likely to be missed by both fecal occult blood test and colonoscopy.
The noninvasive DNA test involves no diet or medication restrictions, no bowel preparation and is done at home using a stool sample. “It is user-friendly, affordable and offers individuals unlimited access by mail,” he added............

Evidence-based Guideline Recommendations on the use of Positron Emission Tomography Imaging in Colorectal Cancer (Ontario provincial Gastrointestinal Disease Site Group)

 Blogger's Note: updated to 2010

Evidence-based Guideline Recommendations on the use of Positron Emission Tomography Imaging in Colorectal Cancer

ACP Calls for Colon Cancer Screening at 50 - in Primary Care, Preventive Care from MedPage Today

Action Points

• Explain that colorectal cancer screening should begin at age 50 for all average-risk individuals, according to a new clinical guideline from the American College of Physicians (ACP), and options include fecal occult blood testing (FOBT), flexible sigmoidoscopy, and colonoscopy.
• Point out that high-risk patients should begin screening at 40 (or 10 years younger than the age when the youngest affected relative was diagnosed), and colonoscopy is the recommended screening modality.

March 6, 2012 - Screening for Colorectal Cancer: A Guidance Statement From the American College of Physicians (pdf) including high risk

Blogger's Note: if searching for Lynch Syndrome, the older term 'HNPCC' will need to be used


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"Genetic or clinical diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC): colonoscopy every one to two years beginning at age 20 to 25 years or 10 years before the age of the youngest case in the immediate family."

abstract: The Stool DNA Test Is More Accurate Than the Plasma Septin 9 Test in Detecting Colorectal Neoplasia (n=30 pts)

Background & Aims

Several noninvasive tests have been developed for colorectal cancer (CRC) screening. We compared the sensitivities of a multimarker test for stool DNA (sDNA) and a plasma test for methylated septin 9 (SEPT9) in identifying patients with large adenomas or CRC.

Conclusions

Based on analyses of paired samples, the sDNA test detects nonmetastatic CRC and large adenomas with significantly greater levels of sensitivity than the SEPT9 test. These findings might be used to modify approaches for CRC prevention and early detection.

abstract: Strengthening the Case for Stool DNA Tests as First-Line Colorectal Cancer Screening: Are We There Yet? (of interest to Lynch Syndrome patients/genetically predisposed)

Blogger's Note: while limited information is available through the abstract it does touch on patient issues regarding screening, this will be of interest to Lynch Syndrome/genetically predisposed patients for which guidelines recommend frequent screening (standard colonoscopy vs virtual colonoscopy)

Abstract

"The incidence of and mortality from colorectal cancer (CRC) have decreased in countries that have established population-based screening programs. In the United States, incidence rates decreased 4% annually from 2003–2007, and mortality decreased by 3.3% per year.¹ During this same time period, rates of screening in the U.S. increased from 50% to 65%,² with colonoscopy-based programs being the predominant strategy in many regions of the country. However, despite increased public education and improved access to colonoscopy in the U.S., 35% of patients still fail to undergo CRC screening,² likely because of this procedure's invasiveness, need for bowel preparation, as well as sedation and missed days of work. Furthermore, the effectiveness of colonoscopy, which has long been considered the gold standard in CRC screening, has recently come into question, with population-based studies demonstrating disappointing outcomes with right-sided lesions and serrated adenomas."