Fecal occult blood tests make cost effective alternatives in colorectal cancer screening

While colonoscopies are the most accurate method for the early detection of colorectal cancers, screening with fecal occult blood tests results in more efficient use of limited budgets, according to a new study by researchers at RTI International.

The study, released today as a web first in Health Affairs, modeled scenarios to assess whether fecal occult blood test or colonoscopy under fixed budget conditions provides the most benefit. The researchers found that, when compared with colonoscopy, under most scenarios high-sensitivity fecal occult blood tests would result in more individuals getting screened with more life years gained.

"There are several state and federally funded colorectal cancer screening programs currently in the United States and many others in the planning stages," said Sujha Subramanian, Ph.D., a senior health economist at RTI and the paper's lead author. "These results will help guide their decisions as a critical challenge facing cancer screening programs, particularly for low-income uninsured individuals, is choosing the screening test that provides the most efficient use of the funding available."

According to the authors, high-sensitivity fecal tests are preferred in the majority of other countries that are screening for colorectal cancer.
The researchers found that a screening program using Hemoccult II, a type of fecal occult blood test, with 60 percent compliance for repeat screening would experience more total life years gained than using a colonoscopy with 100 percent compliance. The compliance could be as low as 40 percent for programs using Hemoccult SENSA, a fecal occult blood test with higher sensitivity for polyp and cancer.

"Under the majority of the scenarios analyzed in this paper, the use of high-sensitivity guaiac fecal occult blood tests will result in more individuals receiving colorectal cancer screening than with colonoscopy and thus will result in a higher number of life-years gained than screening fewer individuals with colonoscopy," Subramanian said.

However, the authors do suggest that colonoscopy screening may be the optimal choice in some circumstances. For instance, they recommend that if it is anticipated that there will be very low compliance with diagnostic follow-up screening recommendations or when repeated annual testing is not feasible, then choosing colonoscopy would be preferable.

According to the American Cancer Society, colorectal cancer is the second leading cause of cancer-related mortality in the United States, and the majority of deaths from this disease are preventable with early detection.