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Fecal Occult Test Failing to Detect Colon Cancer -
Colonoscopy Needed by Older People
Jan. 21, 2005 Fecal occult blood test (FOBT)
performed in-office as part of a digital rectal examination failed to
detect potentially cancerous colon growths 95 percent of the time.
Furthermore, an at-home FOBT was found to detect cancerous polyps less
than 24 percent of the time. The researchers say older people those 50
and over need colonoscopy screening for colorectal cancer, the
second-leading cause of cancer deaths in the United States.
The entire study population received follow-up
colonoscopies, regardless of whether they received digital FOBT or the
at-home stool test, according to the study published in the Jan. 18
issue of the journal Annals of Internal Medicine,
"This study found in-office FOBT as part of a
digital rectal examination to be ineffective, illustrating how important
it is for people to speak with their physician to determine which
colorectal cancer screening test best fits their needs and risk level,"
says AGA President Emmet B. Keeffe, MD.
"No colorectal cancer screening test is perfect.
However, being screened for colorectal cancer using one of the various
methods available is a better fate than not being tested at all. An
alternative use of FOBT is in concert with periodic flexible
sigmoidoscopy of the left portion of the colon, rather than the stool
test alone, he said.
"It is generally preferable to undergo colonoscopy,
which allows complete evaluation of the colon and also, at the same
time, biopsy or removal of most cancers or polyps that are identified.
If detected early as precancerous polyps, the majority of colorectal
cancers are preventable," said Keeffe.
A common screening test for colon cancer fails 75 -
95 percent of the time. Thats the finding about the digital fecal
occult blood test says University of Alabama at Birmingham
gastroenterologist, Christopher Truss, M.D. Some cancers of the colon
bleed every day, but some bleed only once every two weeks. The ability
to catch a specimen is somewhat random. On the other hand, he
explained, Colonscopy examines the rectum and colon directly its
like looking at a hand: You can see the wart instead of waiting for it
to bleed, so you know its there.
Guidelines of multiple agencies and professional
societies underscore the importance of screening for all individuals 50
years of age and older.
Currently, there are several tests that may be used
to screen for colorectal cancer, the second-leading cause of cancer
deaths in the United States. Approved tests include colonoscopy,
flexible sigmoidoscopy, fecal occult blood test and barium enema. Each
screening option has advantages and disadvantages.
About the AGA
The American Gastroenterological Association (AGA) is dedicated to the
mission of advancing the science and practice of gastroenterology.
Founded in 1897, the AGA is the oldest medical-specialty society in the
United States. The AGA's 14,000 members include physicians and
scientists who research, diagnose and treat disorders of the
gastrointestinal tract and liver. On a monthly basis, the AGA publishes
two highly respected journals, Gastroenterology and Clinical
Gastroenterology and Hepatology. The AGA's annual meeting is Digestive
Disease Week, which is held each May and is the largest international
gathering of physicians, researchers and academics in the fields of
gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
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