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Stool-Based Colon Cancer Tests Vary Widely in Accuracy


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One expert noted that stool-based tests were never the "gold standard" for colon cancer detection, so these results are not overly surprising. In that context, "both the guaiac-based test and the immunological tests seemed reasonably sensitive in detecting cancer," said Dr. Durado Brooks, director of colorectal cancer at the American Cancer Society. "But overall, they have relatively poor sensitivity for detecting [colon] polyps."

The implications of the test results are less clear for American physicians, Brooks added, partly because only one of the six immunological tests in the study is currently available in the United States, and partly because the researchers used an older, less popular version of the guaiac test.

In addition, the German researchers used only a single sample for the guaiac-based tests, while the American Cancer Society recommends testing three samples, Brooks said.

Text Continues Below



But another expert said these types of studies are needed.

"The important point of this paper is that you must test these methods in a screening population" before widespread use, said Ann Zauber, an associate attending biostatistician at Memorial Sloan-Kettering Cancer Center in New York City.

Zauber, who is also a member of the U.S. Agency for Health Care Policy and Research's Multi-Society Task Force for Colorectal Cancer, said that "this kind of study needs to be done, and we need to assess these tests against colonoscopy."

The current American Cancer Society recommendation is that Americans over 50 at normal risk for colon cancer get a fecal occult blood test every year; sigmoidoscopy (looking at only the lower colon) once every five years; or a full colonoscopy once every 10 years. The recommendations note that colonoscopy/sigmoidoscopy are the preferred choices, since they are adept at spotting both cancer and polyps. The FOBT typically finds cancers but not polyps. One government advisory group recommended in 2008 that routine screening for colorectal cancer should not be done for people 75 and older.

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Copyright © 2009 ScoutNews, LLC. All rights reserved.
Last updated 2/3/2009

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SOURCES: Durado Brooks, M.D., director, colorectal cancer, American Cancer Society, Atlanta; Ann Zauber, Ph.D., associate attending biostatistician, Memorial Sloan-Kettering Cancer Center, New York City; Feb. 3, 2009, Annals of Internal Medicine


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