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

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.