Screening for fecal occult blood in Israel. Different approaches to recruitment.

Invitations to participate in a screening program for fecal occult blood were sent or given directly to 20,251 people in Israel aged 40 years or above. We received 11,985 requests for stool testing kits, and ultimately we received 7,096 stool specimens (35% response). The highest response was from subjects using their own initiative to participate in the program (62%), followed by members of 23 communal farms, where 59% of subjects submitted specimens. The lowest response came from a low-middle class urban neighborhood (10%), and an intermediate response from an upper middle-class neighborhood (17%). Subsequent to the mail campaigns, a series of local newspaper articles yielded 6,519 specimens. Over all, 59% of subjects requesting kits returned specimens. Among the 7,096 specimens submitted, 145 (2%) were positive for occult blood. One hundred and twelve subjects were evaluated colonoscopically. Sixteen malignancies (14%) and 34 benign growths (30%) were found and resected. The prevalence of benign and malignant large bowel lesions was 7.0 and 7.2 per 1000 specimens in the screened urban and farm communities, respectively. In communities with limited resources for early cancer detection programs, efforts should be directed toward subgroups at risk who are most likely to respond.