Clalit National Cancer Control Center, and Department of Community Medicine and Epidemiology, Carmel Medical Center, B. Rappaport Faculty of Medicine, Haifa, Israel.
Eur J Cancer. 2013 Mar;49(4):923-30. doi: 10.1016/j.ejca.2012.09.020. Epub 2012 Oct 22.
Faecal occult blood (FOB) testing is the most commonly chosen approach in organised population-based colorectal cancer screening programmes throughout the world. Several FOB tests are available which differ in their test qualities. While immunological tests are gaining popularity due to their lower labour intensive analysis and higher standardisation, they are heat labile and more expensive. We studied the real-life experience of a large population-based, organised, screening programme in Israel which employs FOB testing with Hemoccult Sensa, a guaiac test with increased sensitivity that is similar to that of the immunological tests for cancer.
Clalit Health Services is the largest health care provider in Israel. All eligible insurees are actively invited to perform a free-of-charge, home-based, faecal occult blood test, using Hemoccult Sensa. All tests with positive results are followed up and information on colonoscopy, surgical procedures and pathology findings is collected.
During an 18 month period (July 2007-December 2008) 382,792 FOBT tests (in 325,851 people) were performed by the target population, of them 85% Jews and 15% Arabs. Seven hundred and eighteen colorectal cancers and 2652 adenomas were detected. The overall test positivity rate in repeatedly-tested people was 4.2%. The overall detection rate of colorectal cancer in the subsequent tests was 1.7/1000 reflecting 91% of the expected period-incidence of CRC. 70% of the cancers were detected at stages Duke's B2 and lower. Left-sided cancers were detected at a significantly better stage than right-sided cancers (P<0.001). Detection rates among Arabs were somewhat lower than among Jews but the screening programme led to a meaningful increase in national incidence rate in this subgroup by detecting tumours that were otherwise asymptomatic.
The Clalit organised colorectal cancer screening programme, using low cost Hemoccult Sensa, has reached the targets of very high detection rate of cancers, most of them at low stage while keeping a low positivity rate. This approach demonstrates an efficient field-tested alternative to other, more costly, screening options.
粪便潜血（FOB）检测是目前全球范围内组织人群为基础的结直肠癌筛查项目中最常选择的方法。有几种 FOB 检测方法，它们在检测质量上有所不同。虽然免疫检测因其劳动强度较低的分析和更高的标准化而越来越受欢迎，但它们是热不稳定的，而且更昂贵。我们研究了以色列一个大型人群为基础、组织良好的筛查项目的实际经验，该项目使用 Hemoccult Sensa 进行 FOB 检测，Hemoccult Sensa 是一种灵敏度增加的愈创木脂检测，与免疫检测癌症的灵敏度相似。
Clalit 医疗保健服务是以色列最大的医疗保健提供商。所有符合条件的被保险人都被积极邀请进行免费的、基于家庭的粪便潜血检测，使用 Hemoccult Sensa。所有检测结果阳性的都进行随访，并收集结肠镜检查、手术程序和病理发现的信息。
在 18 个月的时间里（2007 年 7 月至 2008 年 12 月），目标人群进行了 382792 次 FOBT 检测（325851 人），其中 85%是犹太人，15%是阿拉伯人。共发现 718 例结直肠癌和 2652 例腺瘤。在反复检测的人群中，总体检测阳性率为 4.2%。随后检测中结直肠癌的总体检出率为 1.7/1000，反映了 CRC 的 91%预期期间发病率。70%的癌症处于 Dukes'B2 及以下阶段。左侧癌症的检出阶段明显优于右侧癌症（P<0.001）。阿拉伯人的检出率略低于犹太人，但筛查计划通过检测无症状的肿瘤，使该亚组的国家发病率显著增加，从而带来了有意义的变化。
Clalit 组织的结直肠癌筛查计划使用低成本的 Hemoccult Sensa，达到了非常高的癌症检出率的目标，其中大多数癌症处于低阶段，同时保持低阳性率。这种方法展示了一种经过现场测试的有效替代方案，优于其他更昂贵的筛查选择。
