Fecal occult blood testing in a noncompliant inner city minority population: Increased compliance and adherence to screening procedures without loss of test sensitivity using stool obtained at the time of in-office rectal examination
A. Parikh et al., Fecal occult blood testing in a noncompliant inner city minority population: Increased compliance and adherence to screening procedures without loss of test sensitivity using stool obtained at the time of in-office rectal examination, AM J GASTRO, 96(6), 2001, pp. 1908-1913
OBJECTIVES: Fecal occult blood screening is cost-effective, is easily admin
istered to large groups of patients, and reduces mortality associated with
colorectal cancer, Within our predominant African American and Latino inner
city clinic populations, compliance with common screening procedures is su
boptimal. A procedure with increased compliance is needed to adequately scr
een this population at high risk for colorectal cancer. The objective of th
is study was to compare the results of the 3-day at-home hemoccult test for
occult blood to those of a hemoccult test performed from stool obtained at
rectal examination in the office.
METHODS: A total of 350 consecutive patients referred to the GI clinic of U
niversity Hospital or Jersey City Medical Center for colorectal cancer scre
ening had both the 3-day at-home hemoccult test and an in-office hemoccult
examination performed, followed by either sigmoidoscopy (for negative resul
ts) or by colonoscopy (for positive results). RESULTS: Patients were noncom
pliant with dietary restrictions, 3-day card return, follow-up appointments
, and endoscopy with conventional screening methods. Decisions based on the
in-office examination with direct scheduling of endoscopy significantly im
proved compliance with followup. There was no statistical difference betwee
n the two detection methods, suggesting that the in-office examination was
the more effective screening test.
CONCLUSIONS: Endoscopy based on an in-office hemoccult examination is an ac
ceptable alternative to using the 3-day at-home stool collection to govern
endoscopic choices. In a noncompliant inner city population, use of the in-
office examination increased compliance with follow up, potentially allowin
g more patients exposure to screening. (C) 2001 by Am. Coll. of Gastroenter
ology.