Role of upper gastrointestinal investigations in a screening study for colorectal neoplasia.

Should patients with positive faecal occult blood screening tests who are free of colorectal neoplasia undergo upper gastrointestinal investigation? Altogether 16,985 faecal occult blood tests were completed in a group of 18,818 asymptomatic patients (45-75 years) offered screening at two yearly intervals. A total of 447 (2.6%) were positive and underwent large bowel investigations. No neoplastic disease was identified in 283 (63%) of them. Fourteen (5%) also underwent gastroscopy for upper gastrointestinal symptoms, benign conditions were identified in five and a gastric carcinoma in one. No further investigations were instituted in the remaining 269 subjects who have now been followed up for a median period of 5 years (2-8 years). Five have been referred for benign upper gastrointestinal conditions, but none for upper gastrointestinal malignancy. Thirty one subjects have died - one from gastric cancer (a patient who had undergone a previous partial gastrectomy for a duodenal ulcer and who had persistent upper gastrointestinal symptoms). The remaining deaths were unrelated to the upper gastrointestinal tract. Nineteen people who have left the trial area have been monitored for the development of malignant disease; none have presented with upper gastrointestinal malignancy. These data support the view that upper gastrointestinal investigations need not be performed routinely in this group of subjects, but may be reserved for those with relevant symptoms.

[1]  B. Lin,et al.  EARLY GASTRIC CANCER , 1974 .

[2]  S. Moss,et al.  RANDOMISED, CONTROLLED TRIAL OF FAECAL OCCULT BLOOD SCREENING FOR COLORECTAL CANCER Results for First 107 349 Subjects , 1989, The Lancet.

[3]  J. Hardcastle,et al.  Epidemiological study of asymptomatic inflammatory bowel disease: the identification of cases during a screening programme for colorectal cancer. , 1989, Gut.

[4]  E. Haglind,et al.  Screening and rescreening for colorectal cancer. A controlled trial of fecal occult blood testing in 27,700 subjects , 1988 .

[5]  E. Haglind,et al.  Screening and rescreening for colorectal cancer. A controlled trial of fecal occult blood testing in 27,700 subjects. , 1988, Cancer.

[6]  O. Kronborg,et al.  Initial mass screening for colorectal cancer with fecal occult blood test. A prospective randomized study at Funen in Denmark. , 1987, Scandinavian journal of gastroenterology.

[7]  W. Allum,et al.  Programme for early detection of gastric cancer. , 1986, British medical journal.

[8]  D. Frommer,et al.  Immunochemical detection of fecal occult blood. , 1985, Australian and New Zealand journal of medicine.

[9]  Hardcastle Jd,et al.  The results of 1115 patients with colorectal cancer treated over an 8-year period in a single hospital. , 1985 .

[10]  N. Armitage,et al.  A comparison of an immunological faecal occult blood test Fecatwin sensitive/FECA EIA with Haemoccult in population screening for colorectal cancer. , 1985, British Journal of Cancer.

[11]  W. Taylor,et al.  Fecal blood levels in health and disease. A study using HemoQuant. , 1985, The New England journal of medicine.

[12]  J. Hardcastle,et al.  The results of 1115 patients with colorectal cancer treated over an 8-year period in a single hospital. , 1985, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[13]  G. Haas,et al.  The prevalence of hemorrhoids , 1983, Diseases of the colon and rectum.

[14]  A. Miller,et al.  Trends in cancer mortality and epidemiology , 1983, Cancer.

[15]  K. Goulston,et al.  False positive and negative hemoccult reactions on a normal diet and effect of diet restriction. , 1980, Australian and New Zealand journal of medicine.

[16]  Burkitt Dp,et al.  Diverticular disease of the colon, a 20th century problem. , 1975 .

[17]  D. Burkitt,et al.  Diverticular disease of the colon, a 20th century problem. , 1975, Clinics in gastroenterology.

[18]  E. Hughes,et al.  Results of Treatment of Carcinoma of Colon and Rectum , 1963, British medical journal.