Hughes Karen, Leggett Barbara, Del Mar Christopher, Croese John, Fairley Stephen, Masson John, Aitken Joanne, Clavarino Alexandra, Janda Monika, Stanton Warren R, Tong Shilu, Newman Beth
School of Public Health and Centre for Health Research, Qld University of Technology, Queensland.
Aust N Z J Public Health. 2005 Aug;29(4):358-64. doi: 10.1111/j.1467-842x.2005.tb00207.x.
To describe patient participation and clinical performance in a colorectal cancer (CRC) screening program utilising faecal occult blood test (FOBT).
A community-based intervention was conducted in a small, rural community in north Queensland, 2000/01. One of two FOBT kits--guaiac (Hemoccult-II) or immunochemical (!nform)--was assigned by general practice and mailed to participants (3,358 patients aged 50-74 years listed with the local practices).
Overall participation in FOBT screening was 36.3%. Participation was higher with the immunochemical kit than the guaiac kit (OR=1.9, 95% CI 1.6-2.2). Women were more likely to comply with testing than men (OR=1.4, 95% CI 1.2-1.7), and people in their 60s were less likely to participate than those 70-74 years (OR=0.8, 95% CI 0.6-0.9). The positivity rate was higher for the immunochemical (9.5%) than the guaiac (3.9%) test (chi2=9.2, p=0.002), with positive predictive values for cancer or adenoma of advanced pathology of 37.8% (95% CI 28.1-48.6) for !nform and 40.0% (95% CI 16.8-68.7) for Hemoccult-II. Colonoscopy follow-up was 94.8% with a medical complication rate of 2-3%.
An immunochemical FOBT enhanced participation. Higher positivity rates for this kit did not translate into higher false-positive rates, and both test types resulted in a high yield of neoplasia.
In addition to type of FOBT, the ultimate success of a population-based screening program for CRC using FOBT will depend on appropriate education of health professionals and the public as well as significant investment in medical infrastructure for colonoscopy follow-up.
描述在使用粪便潜血试验（FOBT）的结直肠癌（CRC）筛查项目中患者的参与情况和临床效果。
2000/01年在昆士兰州北部一个小型农村社区开展了一项基于社区的干预措施。由全科医生分配两种FOBT检测试剂盒之一——愈创木脂法（Hemoccult-II）或免疫化学法（!nform），并邮寄给参与者（当地诊所登记的3358名年龄在50 - 74岁的患者）。
FOBT筛查的总体参与率为36.3%。免疫化学试剂盒的参与率高于愈创木脂法试剂盒（OR = 1.9，95%可信区间1.6 - 2.2）。女性比男性更有可能遵守检测要求（OR = 1.4，95%可信区间1.2 - 1.7），60多岁的人比70 - 74岁的人参与可能性更低（OR = 0.8，95%可信区间0.6 - 0.9）。免疫化学法检测的阳性率（9.5%）高于愈创木脂法（3.9%）（χ² = 9.2，p = 0.002），!nform检测对癌症或晚期病理腺瘤的阳性预测值为37.8%（95%可信区间28.1 - 48.6），Hemoccult-II为40.0%（95%可信区间16.8 - 68.7）。结肠镜检查的随访率为94.8%，医疗并发症发生率为2 - 3%。
免疫化学法FOBT提高了参与率。该试剂盒较高的阳性率并未转化为更高的假阳性率，两种检测类型都导致了较高的肿瘤检出率。
除了FOBT的类型外，使用FOBT进行基于人群的CRC筛查项目的最终成功将取决于对卫生专业人员和公众的适当教育，以及对结肠镜检查随访医疗基础设施的大量投资。
