[Performance of the Hemoccult test in the screening of colorectal cancer and adenoma. Results of 5 screening campaigns in Saône-et-Loire]

Abstract

Objectives: The aim of this population-based study was to specify the positivity rate, the positive predictive value of Hemoccult test as well as the characteristics of the cancers and adenomas screened during the successive colorectal cancer screening campaigns.

Methods: This study focused on five colorectal cancer mass screening campaigns by Hemoccult test carried out between 1988 and 1996. The test was offered every two years to a cohort of subjects born between 1914 and 1943 and living in some districts of the Saône-et-Loire administrative area.

Results: The positivity rate of the test was higher in the first campaign (2.1%) than in the subsequent ones (mean 1.3%). It was also higher in males than in females and it increased with age. After a positive test, 85.4% of the subjects had a colonic exploration. The exploration rate was higher when the test was offered by general practitioners (88.0%) than when it was mailed (77.8%) (P < 0.01). Through this test, cancer was detected in 168 patients, and one adenoma or more in 414 patients. The positive predictive value was 11.4% for cancer, 17.1% for adenoma > or = 1 cm and 11.1 for adenoma < 1 cm. It was higher in males than in females and it increased with age. Depending on the campaigns, 35.9% to 47.3% of the subjects explored after a positive test had a cancer or an adenoma. The screened cancers or adenomas were more often localized in the sigmoid or the rectum. Three quarters of screened cancers were stage I or II (TNM classification). All together, 82.7% of cancers were treated with surgical resection for cure and 10.1% with endoscopic resection.

Conclusions: This work confirms the feasibility of carrying out regular colorectal cancer screening campaigns, through which a few subjects can be selected for undergoing colonic explorations. These latter can detect a cancer or adenoma in 40% of cases.