Guaiac versus immunochemical tests: Faecal occult blood test screening for colorectal cancer in a rural community

Hughes, Karen, Leggett, Barbara, Del Mar, Christopher, Croese, John, Fairley, Stephen, Masson, John, Aitken, Joanne, Clavarino, Alexandra, Janda, Monika, Stanton, Warren R., Tong, Shilu, & Newman, Beth (2005) Guaiac versus immunochemical tests: Faecal occult blood test screening for colorectal cancer in a rural community. Australian and New Zealand Journal of Public Health, 29(4), pp. 358-364.

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Objective: To describe patient participation and clinical performance in a colorectal cancer (CRC) screening program utilising faecal occult blood test (FOBT).

Methods: A community-based intervention was conducted in a small, rural community in north Queensland, 2000/01. One of two FOBT kits – guaiac (Hemoccult-ll) or immunochemical (Inform) – was assigned by general practice and mailed to participants (3,358 patients aged 50–74 years listed with the local practices).

Results: Overall participation in FOBT screening was 36.3%. Participation was higher with the immunochemical kit than the guaiac kit (OR=1.9, 95% Cl 1.6-2.2). Women were more likely to comply with testing than men (OR=1.4, 95% Cl 1.2-1.7), and people in their 60s were less likely to participate than those 70–74 years (OR=0.8, 95% Cl 0.6-0.9). The positivity rate was higher for the immunochemical (9.5%) than the guaiac (3.9%) test (χ2=9.2, p=0.002), with positive predictive values for cancer or adenoma of advanced pathology of 37.8% (95% Cl 28.1–48.6) for !nform and 40.0% (95% Cl 16.8–68.7) for Hemoccult-ll. Colonoscopy follow-up was 94.8% with a medical complication rate of 2–3%.

Conclusions: An immunochemical FOBT enhanced participation. Higher positivity rates for this kit did not translate into higher false-positive rates, and both test types resulted in a high yield of neoplasia.

Implications: In addition to type of FOBT, the ultimate success of a population-based screening program for CRC using FOBT will depend on appropriate education of health professionals and the public as well as significant investment in medical infrastructure for colonoscopy follow-up.

Impact and interest:

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ID Code: 91445
Item Type: Journal Article
Refereed: Yes
DOI: 10.1111/j.1467-842X.2005.tb00207.x
ISSN: 1753-6405
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > ONCOLOGY AND CARCINOGENESIS (111200)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2005 John Wiley & Sons, Inc.
Copyright Statement: This is the peer reviewed version of the following article: Hughes, K., Leggett, B., Mar, C. D., Croese, J., Fairley, S., Masson, J., Aitkne, J., Clavarino, A., Janda, M., Stanton, W. R., Tong, S. and Newman, B. (2005), Guaiac versus immunochemical tests: faecal occult blood test screening for colorectal cancer in a rural community. Australian and New Zealand Journal of Public Health, 29: 358–364, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Deposited On: 22 Dec 2015 00:26
Last Modified: 22 Dec 2015 00:27

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