The five-year results of the UK Bowel Cancer Screening Pilot study show that biennial use of the fecal occult blood test (FOBT) decreases emergency presentations for colorectal cancer (CRC) and dramatically reduces 30-day postoperative mortality, trial authors report the journal
Gut, released online November 29th.
Dr. Steve J. Goodyear, at the University Hospitals Coventry and Warwickshire NHS Trust, and colleagues note that emergency surgery for CRC is associated with a high perioperative mortality rate.
The English arm of the pilot study involved a population-based sample of 187,777 individuals ages 50 to 69 years. The team analyzed data for the subjects between 1999 and 2004, with 1999 representing the 'pre-screening year.'
"The success of the pilot screening program is reflected by the uptake rates and compliance with FOB testing (56.8 per cent in round 1 and 51.9 per cent in round 2)," Dr. Goodyear told Reuters Health.
Following positive FOBT results, approximately 1700 colonoscopies were performed in the first round and 1000 in the second round of screening. Corresponding detection rates were 1.62 and 0.94 per 1000 colonoscopies. During the entire period, 1236 new cases of CRC were diagnosed.
The proportion of patients with CRC who were admitted on an emergency basis decreased from 29.4 per cent in 1999 to 15.8 per cent by 2004 (p = 0.001). Corresponding 30-day operative mortality rates among patients undergoing emergency surgery decreased from 48 to 13 per cent.
Twenty-three stomas were created in 2000, versus ten in 2004. However, Duke stage C carcinoma was the most common diagnosis among patients admitted through the emergency department throughout the study period.
"We sincerely hope that increased publicity surrounding Bowel Cancer Screening within the UK will increase uptake rates, further improving detection and patient outcomes," Dr. Goodyear said.
The investigator noted that the American College of Gastroenterology recommends primary colonoscopy as the 'gold-standard' first-line investigation for CRC screening. However, in both the UK and the US, he notes, "colonoscopic capacity is limited."
"FOBT followed by invasive testing has been shown to be more cost-effective and acceptable to the general population than primary colonoscopy or sigmoidoscopy," he added. "As acceptability and compliance are inextricably linked, it is our feeling that increased uptake is more likely with a FOBT protocol than with a primary invasive procedure.
