Kaiser Permanente Study Shows Under Used Colon Cancer Screening Test Is Effective
Improved Fecal Occult Blood Tests (FOBT) called Fecal Immunochemical Tests (FITs), look for human blood in the stool and are more effective at detecting cancers and polyps than the older and more widely used stool screening tests -- the guaiac tests (GTs), said James Allison, MD, an adjunct investigator with the Kaiser Permanente Division of Research, UCSF Clinical Professor of Medicine Emeritus and lead author of the study.
Investigators and gastroenterologist clinicians at Kaiser Permanente's Northern California Division of Research compared the performance of FIT and a sensitive GT in 5,841 people with an average risk for colorectal cancer and looked at the tests' ability to detect colorectal cancers and polyps in people with the disease (sensitivity) and the tests' ability to determine which people do not have the disease (specificity).
The FIT had a sensitivity of 81.8% for detecting colorectal cancers and a specificity of 96.9%. The GT was 64.3% sensitive for detecting colorectal cancers and 90.1% specific. The higher specificity of the FIT means that there are fewer false positive results and, therefore, fewer interventional procedures need to be performed in patients without disease, said the researchers.
"FIT is an important and a welcome addition to our screening tool kit, especially because according to the National Cancer Institute, colorectal cancer screening rates continue to lag well behind those for other cancers. All recommended screening tests are effective tools for detecting colorectal cancer early, when it is highly curable," said Allison. "No screening test is perfect, but any is better than none, and ultimately, the best screening test is the one the patient actually completes." FIT is convenient for patients because it is easy to prepare and complete at home and does not involve dietary restriction, explained the researchers.
FIT is more specific than the sensitive GT for detecting cancers and polyps because it detects human blood in the stool. The GT, on the other hand, detects peroxidase activity found in both human and non-human blood as well as in many vegetables such as broccoli and horseradish. This can lead to more false positives, explained the researchers.
FIT has other advantages as well, according to the researchers. Some FITs can be developed and interpreted by lab equipment. This innovation allows for management of large numbers of tests in a standardized manner with excellent quality assurance, they explained.
The study was funded by the National Cancer Institute, American Digestive Health Foundation Outcomes Research Training Award, Kaiser Foundation Health Plan Community Benefit Program, The Permanente Medical Group Innovation Program; Beckman Coulter, Inc., and Enterix Corporation.
Additional authors on this study include Theodore R Levin, Jo P. Tucker, Irene S. Tekawa, Wei K. Zhao, and Joseph Selby all from the Kaiser Permanente Division of Research in Oakland, Ca; Albert M. Palitz, from the department of gastroenterology, Kaiser Permanente Medical Center in Walnut Creek; Lori C. Sakoda, department of epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle; Thomas Cuff, department of medicine, Kaiser Permanente Medical Center in Richmond, CA; Mary Pat Pauley, department of medicine Kaiser Permanente Medical Center, Sacramento; Lyle Shlager, department of internal medicine Kaiser Permanente Medical Center, San Francisco; J. Sanford Schwartz, department of medicine, University of Pennsylvania; David F. Ransohoff, departments of medicine and epidemiology, University of North Carolina at Chapel Hill.
About Kaiser Permanente
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 400-plus staff is working on more than 250 epidemiological and health services research projects.
Kaiser Permanente is America's leading integrated health plan. Founded in 1945, it is a not-for-profit; group practice prepayment program headquartered in Oakland, Calif. Kaiser Permanente serves the health care needs of more than 8.7 million members in nine states and the District of Columbia. Today it encompasses the not-for-profit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 156,000 technical, administrative and clerical employees and caregivers, and more than 13,000 physicians representing all specialties.
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