Letter to the Editor

Diagnosis of Colon and Rectal Cancer in a Large VA Medical Center Practice: Does Fecal Occult Blood Screening Make a Difference?

Authors: Peter A. Engel, MD, Gurjeet S. Kahlon, MD, Syed Shah, MD

Abstract

Screening of average-risk patients for colorectal cancer by annual fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy has demonstrated efficacy in both the prevention and earlier detection of this malignancy in adults 50 years or older.1,2 In 1998, the Albany VA Medical Center launched a systematic program of colorectal cancer screening that uses home FOBT as the principal screening modality, based on its low cost, safety, and high patient acceptability.3 Over the next 4 years, screening rates more than doubled, to 66%, with greater than 90% by FOBT in an eligible population numbering more than 27,800. This study examines the impact of this screening initiative on the discovery of colorectal cancers during years 3 to 5% of the program. Results indicate that detection of fecal occult blood in asymptomatic patients led to fewer than 5 of colorectal cancer diagnoses

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References

1.Walsh MEJ, Terdiman JP. Colorectal cancer screening scientific review. JAMA 2003;289:1288–1296.
 
2.Faivre J, Dancourt V, Lejeune C, et al. Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study. Gastroenterology 2004;126:1674–1680.
 
3.Jha AK, Prelin JB, Kizer KW, et al. Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. N Engl J Med 2003;348:2218–2227.
 
4.Colon and rectum. In: American Joint Committee on Cancer. AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002. pp. 113–124.
 
5.Fijten GH, Starmans R, Muris JWM, et al. Predictive value of signs and symptoms for colorectal cancer in patients with rectal bleeding in general practice. Fam Pract 1995;12:279–286.