Rennert G, Rennert H S, Miron E, Peterburg Y
Department of Community Medicine, Carmel Medical Center and Technion Faculty of Medicine, Haifa 34362, Israel.
Cancer Epidemiol Biomarkers Prev. 2001 Nov;10(11):1165-8.
Screening for early detection of colorectal cancer using fecal occult blood testing has been shown to be effective in reducing mortality from this disease. The largest Health Maintenance Organization in Israel initiated the use of Hemoccult Sensa in 1992 to evaluate the field performance of this test. All primary care physicians were invited to order home-based tests for their asymptomatic patients 50-74 years of age. This report summarizes the results of 45,166 tests performed, 22,193 in the prevalence round. Seventy-eight cancers, 60 patients with adenomas, and 163 patients with polyps were detected, yielding a cancer detection rate of 2.61/1,000 screened in the prevalence round. Of these, 21.6% were in the right colon. Of screen-detected cancers, 44.5% and 58.9% were detected in Dukes' A and in situ stages in the prevalence and incidence rounds, correspondingly. The overall estimated sensitivity of the test (median follow-up, 35 months) was 85.3% for the prevalence round with a specificity of 95.5%. The sensitivity for left-side tumors (87.9%) was higher than for right-side or rectal tumors (78.6%). The positive predictive value for cancer increased with increasing number of positive fields. Four or more positive fields had a positive predictive value for cancer of 16-26% and a positive predictive value of 46-71% for all tumors combined. Population screening with a sensitive fecal occult blood test performs well outside a trial setting, detecting a high proportion of expected tumors with favorable stage distribution. Given its proven power to significantly reduce mortality, use of this test is strongly advised to both medical organizations and the healthy population at average risk.
使用粪便潜血检测进行结直肠癌早期检测的筛查已被证明在降低该疾病死亡率方面是有效的。以色列最大的健康维护组织于1992年开始使用Hemoccult Sensa来评估该检测的实际应用效果。所有初级保健医生都被邀请为其50至74岁的无症状患者安排居家检测。本报告总结了所进行的45,166次检测的结果，其中在患病率调查轮次中有22,193次检测。共检测出78例癌症、60例腺瘤患者和163例息肉患者，在患病率调查轮次中筛查出的癌症检测率为2.61/1000。其中，21.6%位于右半结肠。在筛查出的癌症中，在患病率和发病率调查轮次中，分别有44.5%和58.9%的癌症在Dukes' A期和原位阶段被检测到。该检测的总体估计敏感性（中位随访时间为35个月）在患病率调查轮次中为85.3%，特异性为95.5%。左侧肿瘤的敏感性（87.9%）高于右侧或直肠肿瘤（78.6%）。癌症的阳性预测值随着阳性视野数量的增加而增加。四个或更多阳性视野对癌症的阳性预测值为16 - 26%，对所有肿瘤合并的阳性预测值为46 - 71%。在试验环境之外，使用敏感的粪便潜血检测进行人群筛查效果良好，能检测出高比例的预期肿瘤，且分期分布良好。鉴于其已被证明能显著降低死亡率，强烈建议医疗机构和平均风险的健康人群使用该检测。
