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    1 Comment for this article
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    Burden/benefit balance might be better with FIT test than with FOBT
    Anne Peticolas, MA | University of Texas at Austin
    I heartily applaud Dr. Kistler et al.'s interesting study of real world results of screening, including downsides. The authors mention as limitations to their study the mostly male VA population and small sample size. Another important limitation should be mentioned. Given the year (2001) when FOBT studies were done, the FOBT screening test studied was almost certainly the fecal guaiac test. Nowadays, a much better choice of a fecal immunochemical test (FIT) is available for fecal screening. FIT tests are more selective for bleeding of colorectal origin, and the test remains reasonable in cost. The factors the authors mention, such as life expectancy and willingness to have a colonoscopy in case of a positive result, are still important considerations in choosing whether to screen at all, but the relative balance of burdens and benefits may well be somewhat more favorable with the currently-available FIT tests than with fecal guaiac screening; and this should have been mentioned.

    Conflict of Interest: None declared
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Original Investigation
    Aug 8 2011

    Long-term Outcomes Following Positive Fecal Occult Blood Test Results in Older Adults: Benefits and Burdens

    Author Affiliations

    Author Affiliations: Department of Family Medicine, University of North Carolina at Chapel Hill (Dr Kistler); Division of Geriatrics, San Francisco Veterans Affairs Medical Center, and University of California, San Francisco (Mss Kirby and Casadei and Dr Walter); and University of Arkansas School of Medicine (Ms Lee).

    Arch Intern Med. 2011;171(15):1344-1351. doi:10.1001/archinternmed.2011.206
    Abstract

    Background In the United States, older adults have low rates of follow-up colonoscopy after a positive fecal occult blood test (FOBT) result. The long-term outcomes of these real world practices and their associated benefits and burdens are unknown.

    Methods Longitudinal cohort study of 212 patients 70 years or older with a positive FOBT result at 4 Veteran Affairs (VA) facilities in 2001 and followed up through 2008. We determined the frequency of downstream outcomes during the 7 years of follow-up, including procedures, colonoscopic findings, outcomes of treatment, complications, and mortality based on chart review and national VA and Medicare data. Net burden or benefit from screening and follow-up was determined according to each patient's life expectancy. Life expectancy was classified into 3 categories: best (age, 70-79 years and Charlson-Deyo comorbidity index [CCI], 0), average, and worst (age, 70-84 years and CCI, ≥4 or age, ≥85 years and CCI, ≥1).

    Results Fifty-six percent of patients received follow-up colonoscopy (118 of 212), which found 34 significant adenomas and 6 cancers. Ten percent experienced complications from colonoscopy or cancer treatment (12 of 118). Forty-six percent of those without follow-up colonoscopy died of other causes within 5 years of FOBT (43 of 94), while 3 died of colorectal cancer within 5 years. Eighty-seven percent of patients with worst life expectancy experienced a net burden from screening (26 of 30) as did 70% with average life expectancy (92 of 131) and 65% with best life expectancy (35 of 51) (P = .048 for trend).

    Conclusions Over a 7-year period, older adults with best life expectancy were less likely to experience a net burden from current screening and follow-up practices than are those with worst life expectancy. The net burden could be decreased by better targeting FOBT screening and follow-up to healthy older adults.

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