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CLINICAL GUIDELINE: PART I: Suggested Technique for Fecal Occult Blood Testing and Interpretation in Colorectal Cancer Screening
- American College of Physicians* *This paper, written by David F. Ransohoff, MD, and Christopher A. Lang, MD, was developed for the Health and Public Policy Committee by the Clinical Efficacy Assessment Subcommittee: George E. Thibault, MD, Chair; John R. Feussner, MD, Co-Chair; Anne-Marie J. Audet, MD; Gottlieb C. Friesinger Jr., MD; Daniel L. Kent, MD; Keith I. Marton, MD; Valerie Anne Palda, MD; John J. Whyte, MD; and Preston L. Winters, MD. This paper was approved by the Board of Regents on 26 October 1996. Requests for Reprints: Customer Service Representative, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA 19106-1572.
The numbers in square brackets are cross-references to the numbered sections in the accompanying paper, “Screening for Colorectal Cancer with the Fecal Occult Blood Test: A Background Paper,” which is part II of this guideline (see pages 811-822).
Strong evidence from three randomized, controlled trials indicates that screening with fecal occult blood tests reduces mortality rates associated with colorectal cancer. Other evidence shows a benefit for screening with sigmoidoscopy. One or both screening methods are almost universally endorsed today.
These guidelines are primarily concerned with the technique of screening by using fecal occult blood tests, with special emphasis on the interpretation of positive and negative test results and the subsequent work-up of persons with positive results. They do not address the question of whether to screen or the decision to use fecal occult blood testing alone, sigmoidoscopy alone, or both. These issues are addressed elsewhere.
This discussion reflects a synthesis of data published through 1996. Although some features of these recommendations are expected to remain stable for the next few years, others-particularly those on the type of fecal occult blood test used and the frequency of screening-may evolve substantially as new data become available. One purpose of the accompanying background paper is to provide a conceptual framework for assessing future developments.
Background
Colorectal cancer is a major cause of cancer-related death in the United States and many other countries. Because of its generally favorable clinical biology, it is an appropriate target for screening. About 6% of persons will develop colorectal cancer by 80 years of age, and half of these persons will die as a result. Screening for colorectal cancer has been recommended for many years, but the lack of a randomized, controlled trial showing proof of benefit was a barrier to widespread implementation. However, convincing evidence from three randomized, controlled …
