Screening for carcinoma of the colon: Pitfalls of the Hemoccult® test
Colorectal carcinoma fulfills most of the criteria for disease screening. It occurs frequently in the general population, early detection results in longer survival, and premalignant polyps can often be detected and eradicated. Occult blood testing is safe, simple, inexpensive, and has been shown to detect asymptomatic carcinomas. Considering the information currently available, this enthusiasm should be tempered by the potential pitfalls of lead-time, length, and selection biases, along with the recognition that occult blood testing misses about one-third of the carcinomas and two-thirds of the adenomatous polyps present. Despite these drawbacks and although it has not been proved that screening for colorectal carcinoma by stool occult blood testing reduces mortality, the incidence and mortality of colorectal cancer mandate a strategy for the practicing physician. A reasonable approach with the current state of knowledge is the use of fecal occult blood testing combined with flexible fiberoptic sigmoidoscopy.
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