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Fecal Occult Blood Testing: 30-Year Results

Hello. I am Dr. David Johnson, Professor of Medicine and Chief of Gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia. I have just returned from San Diego and the annual meeting of the American College of Gastroenterology (ACG). As usual, a plethora of great science was presented, and I thought I would present my "top 10" areas of interest from the meeting that may be applicable to best practice.

I will start with the President Plenary Sessions. There were a number of plenary sessions that were very provocative. One was given by Dr. Aasma Shaukat[1] from the University of Minnesota Veterans Affairs Medical Center in Minneapolis. She presented the 30-year follow-up of the fecal occult blood test trial. This was just published in the New England Journal of Medicine [2]in the September 19 issue. This study began in 1976 and continued until 1982, and then there was a second phase of screening from 1986 to 1992. It involved more than 46,000 patients aged 50-80 who were randomly assigned to either annual fecal occult blood testing (FOBT), biennial FOBT, or a control group.

The 30-year follow-up looked at death rates, and more than 70% of the patients had died. The colon cancer-related mortality rate was 1.8% in the annual screening group, 2.2% in the biennial group, and 2.7% in the control group. This equates to a 32% reduction in risk for colon cancer with annual FOBT and 22% for biennial FOBT. It shows a sustained effect of reduction in mortality with FOBT, primarily as a result of polypectomies performed during the colonoscopies in patients referred with positive FOBT.

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