OAKLAND, Calif. – An underused colon cancer screening test now available in the United States effectively detects colorectal cancer and may help to improve colon cancer screening rates, according to investigators at the Kaiser Permanente Division of Research. The study appears in the September 25, 2007, issue of the Journal of the National Cancer Institute.
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 percent for detecting colorectal cancers and a specificity of 96.9 percent. The GT was 64.3 percent sensitive for detecting colorectal cancers and 90.1 percent 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, Calif.; 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 the Kaiser Permanente Division of Research
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.
About Kaiser Permanente
About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.