The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial

The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial

We conducted a cluster-randomized trial aimed at assessing the effect of the type of faecal occult blood, guaiac or immunochemical test on screening compliance. We sampled 130 general practitioners (GPs) who consented to participate in the trial. We randomly allocated half of them to the guaiac (Hem...

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Bibliographic Details
Published in:Journal of medical screening Vol. 12; no. 2; p. 83
Main Authors: Federici, Antonio, Giorgi Rossi, Paolo, Borgia, Piero, Bartolozzi, Francesco, Farchi, Sara, Gausticchi, Gabriella
Format: Journal Article
Language:English
Published: England 01-01-2005
Subjects:
Aged
Cluster Analysis
Colorectal Neoplasms - diagnosis
Female
Guaiac - pharmacology
Humans
Immunochemistry
Indicators and Reagents
Internal Medicine
Male
Mass Screening - economics
Mass Screening - methods
Middle Aged
Occult Blood
Patient Compliance
Predictive Value of Tests
Prevalence
Reagent Kits, Diagnostic
Reproducibility of Results
Sensitivity and Specificity
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Summary:We conducted a cluster-randomized trial aimed at assessing the effect of the type of faecal occult blood, guaiac or immunochemical test on screening compliance. We sampled 130 general practitioners (GPs) who consented to participate in the trial. We randomly allocated half of them to the guaiac (Hemo-Fec) and half to the immunochemical test (OC-Hemodia). We sampled 2/10 of the GPs' 50-75-year-old patients (n=7332) and randomly divided this population into half. One half was invited to be screened at the GP's office and the other to the nearest gastroenterology ward. The principal outcome was the percentage of returned tests. The immunochemical test had a compliance of 35.8% and the guaiac of 30.4% (relative risk [RR] 1.20; 95% confidence interval [CI] 1.02-1.44). The difference was mostly due to a higher probability of returning the sample: 93.8% and 88.6% for immunochemical and guaiac, respectively (RR 1.06; 95% CI 1.02-1.10). The guaiac test had a higher prevalence of positives (10.3% versus 6.3%, RR 0.603; 95% CI 0.433-0.837). There was a higher variability in the results obtained with the guaiac test compared with the immunochemical (F[1, 12] = 16.25; P=0.0017). Compliance is more likely with the immunochemical than the guaiac test, independent of the provider. Guaiac tests show a higher variability of the results among centres. The successful implementation of a screening programme requires a period of standardization of the test reading in order to avoid unexpected work overload for colonoscopy services.
ISSN:0969-1413
DOI:10.1258/0969141053908357