A critical analysis of the largest reported mass fecal occult blood screening program in the United States

Article Abstract:

The prognosis for colorectal cancer correlates directly with the stage of disease progression at diagnosis; five-year survival is almost 90 percent when tumor is limited to the wall of the intestine. This compares with a 20 to 50 percent five-year survival when the lymphatic system is involved; survival is further reduced to 5 percent when there is distant spread of disease. One method of mass screening for early diagnosis of colorectal cancer involves fecal testing for occult blood. The results of a mass screening program, which was undertaken from January 24, 1988 to February 19, 1988, are reported. This program was promoted in the media, including 121 minutes of television coverage. The testing material (Hemoccult-II) was distributed free of charge through pharmacies to 156,000 people; 55,051 tests (35 percent) were completed and returned. Ninety-five percent of those responding had learned of the program via television. The screening identified 3,375 people (6 percent) with blood in their stool sample; 73 percent of these individuals reported that they had followed-up with a physician. Physicians reported follow-ups for only 1,356 patients (55 percent). Thirty-five percent of patients who consulted a physician had neither colonoscopy nor barium enema performed. Thirty-six colorectal cancers and 212 polyps were identified. None of the cancers had reached the stage of distant spread. Eight patients (24 percent) had lymph node involvement, and the other patients had intestinal involvement. It is concluded that early screening can identify early cancers; 64 percent of those diagnosed through this screening program were limited to the wall of the intestine. However, patient and physician compliance was low. Total colon examination is necessary. Also, many procedures and tests performed during follow-up examinations were incomplete or inappropriate, indicating the need for better physician education. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Medical examination, Colorectal cancer, Feces, Medical screening, Health screening, Occult blood

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Thyroglobulin measurement vs iodine 131 total-body scan for follow-up of well-differentiated thyroid cancer

Article Abstract:

The recurrence of thyroid cancer may be detected by measuring blood levels of thyroglobulin, an iodine-containing protein released from the thyroid gland, or by performing a total-body scan using the radioactive substance, sodium iodide 131. In total-body scan, a radioactive substance that concentrates in a specific tissue such as the thyroid is injected into the body, and the radioactive waves released from the substance are recorded on a photographic plate. The effectiveness of blood thyroglobulin measurement and iodine 131 total-body scan in detecting residual (remaining) and recurrent thyroid cancer was assessed by reviewing the medical records of patients from the Milton S. Hershey Medical Center in Hershey, Pennsylvania. The presence of interfering antibodies, specialized immune or natural defense proteins that bind to foreign particles, prevented the measurement of thyroglobulin levels in 17 of 38 cases. In addition, measurement of blood thyroglobulin levels was less sensitive than total body scan for detecting remaining thyroid cancer and cancer of the neck. The results suggest that total body scan using iodine 131 is the preferred method for identifying recurrent thyroid cancer, particularly when complete destruction of the thyroid tissue is the goal of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Thyroid cancer, Radionuclide imaging, Radioisotope scanning, Thyroglobulin

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