SCREENING FOR COLORECTAL NEOPLASMS WITH A NEW IMMUNOLOGICAL HUMAN FECAL HEMOGLOBIN AND ALBUMIN TEST

In Germany, screening for colorectal cancer shows low efficiency, whic h is partly due to demographic changes with a rising mean age of the p opulation, a low participation rate and an unsatisfactory sensitivity of guaiac tests for detecting faecal occult-blood. Therefore, a pilot screening study with a new immunological faecal haemoglobin and albumi n test was performed in Ostringen, Germany to assess its compliance, p erformance characteristics and cost-effectiveness. Two thousand, seven hundred and eighty-five persons (1,498 women and 1,287 men) collected 1 mi samples from two different sites of one stool. The upper limit o f normal was 10 mu g/g stool for haemoglobin and 100 mu g/g stool for albumin. The compliance was 82%; 224 persons (8%) had a positive test result, Of these, 184 underwent full colonoscopy. We detected 14 color ectal cancers, 10 of which were Dukes' stage A carcinomas removed by e ndoscopic polypectomy, 34 large adenomas and 43 small adenomas, The de tection rate for colorectal neoplasms was above the rate described for other immunological haemoglobin tests and for Haemoccult tests. The s pecificity of the test - defined with false-positive results if a norm al colon mucosa and no other reasons for upper or lower gastrointestin al bleeding were found - was 99.5%, The cost-effectiveness was assesse d by comparing the diagnostic costs with the savings resulting from pr evention of colorectal carcinomas by endoscopic polypectomy of maligna nt polyps (Dukes' stage A). The savings in our screening study exceede d the diagnostic costs by approximately 2.3 times. The combined inmuno logical faecal haemoglobin and albumin test should substitute the Haem occult test in colorectal cancer screening because of its higher sensi tivity and specificity combined with cost-effectiveness and good patie nt compliance. (C) 1998 Lippincott Williams & Wilkins.