Are patients more likely to participate in colonoscopy or yearly fecal occult blood testing to screen for colon cancer?
A single screening colonoscopy had higher rates of participation than 5 years of fecal occult blood testing in this study of patients offered free screening (84% vs 73%; P ≤ .001). After 5 years, only 38.4% of participants assigned to fecal occult blood testing completed all the recommended yearly testing. As a result, advanced neoplasia or large serrated lesions were more likely to be identified by colonoscopy than testing.
Plan de l'etude:
Randomized controlled trial (nonblinded)
These researchers enrolled 3523 healthy volunteers, recruited from 3 sites in the United States, who were between the ages of 40 years and 69 years. The participants were randomized, using concealed allocation to receive one no-cost colorectal cancer screening by colonoscopy or annual high-sensitivity guaiac-based fecal occult blood tests (HSgFOBTs) using the Hemoccult II SENSA kit for 5 years. The participants were an average of 55.5 years and most (75%) identified as White. From the start, more people completed colonoscopy screening as compared with HSqFOBT: 84% versus 73% (P ≤ .001). Adherence to all 5 years of HSqFOBT screening was accomplished by only 38.4% of participants, with one-quarter of these participants switching to colonoscopy screening. Using intention-to-treat analysis, adenomas or serrated lesions were identified in 22.7% of the screening colonoscopy arm and 12.2% of the HSqFOBT arm (P < .001). Advanced neoplasia or large serrated lesions were identified in 8.2% of participants who received initial colposcopy (per-protocol analysis). Of the patients who completed the first round of HSqFOBT screening, 4.0% had a positive finding, and 91.4% of these participants followed up with colonoscopy.
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine