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  • Title: Screening for familial colorectal cancer with a sensitive immunochemical fecal occult blood test: a pilot study.
    Author: Gimeno-García AZ, Quintero E, Nicolás-Pérez D, Hernández-Guerra M, Parra-Blanco A, Jiménez-Sosa A.
    Journal: Eur J Gastroenterol Hepatol; 2009 Sep; 21(9):1062-7. PubMed ID: 19307978.
    Abstract:
    OBJECTIVE: Colonoscopy is empirically recommended as the first choice screening strategy in first-degree relatives of patients with colorectal cancer (CRC). However, this strategy is accepted by less than 40% of the risk population and two-thirds of screened individuals and renders a normal exploration. This pilot study assessed the accuracy of a latex agglutination immunochemical fecal occult blood test (LA-FOBT) for detecting advanced colorectal neoplasm (cancer or adenomatous polyps > or =1 cm in size, with villous pattern or high grade dysplasia) in asymptomatic first-degree relatives of patients with CRC. METHODS: One hundred and sixty-nine first-degree relatives of 135 index cases were prospectively included. All participants received a sensitive LA-FOBT (hemoglobin detection limit of 50 ng/ml buffer), and were invited to undergo colonoscopy. On the whole, 116 (69%) participants returned LA-FOBT and underwent colonoscopy. RESULTS: LA-FOBT was positive in 19 of 116 (16%) cases. Colonoscopy detected neoplasms in 49 of 116 (42%) patients: 37 of 116 (32%) were nonadvanced adenomas and 12 of 116 (10%) advanced adenomas. LA-FOBT detected 10 of 12 (83%) advanced adenomas showing a sensitivity, specificity, positive predictive value, and negative predictive value of 83, 91, 53, and 98%, respectively. In patients with positive LA-FOBT, 1.9 colonoscopies were necessary for detecting one advanced adenoma, whereas in case of not performing this test 10 colonoscopies would be needed. Overall, approximately 80% of screening colonoscopies could be precluded using a LA-FOBT. CONCLUSION: One-time screening with LA-FOBT successfully detects advanced colorectal adenomas and may save unnecessary colonoscopies in first-degree relatives of patients with CRC.
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