Screening for colon cancer in Germany

Area of Science:

• Oncology
• Gastroenterology
• Public Health

Background:

• Fecal occult blood testing (Hemoccult) has been a standard part of annual cancer checkups in Germany since 1977.
• Colorectal cancer screening is crucial for early detection and improved patient outcomes.

Purpose of the Study:

• To review the effectiveness of fecal occult blood testing for colon cancer screening and case finding.
• To analyze screening data from 1985-1990, focusing on participation, positivity, and case finding rates.

Main Methods:

• Retrospective analysis of fecal occult blood testing (Hemoccult) results from 1985-1990 in Germany.
• Inclusion of data from approximately 4 million screenees annually.
• Evaluation of test positivity and case finding rates in relation to screening intervals.

Main Results:

• Significant differences observed between males and females in age, participation frequency, test positivity, and case finding rates.
• Approximately 1,500 colorectal cancers detected annually among 4 million screenees.
• Annual screening demonstrated a "screening-out" effect for colon cancer.
• In general medical practice, fecal occult blood testing showed higher positivity and case finding rates compared to mass screening, with positive predictive values of 11% for cancer and 20% for large adenomatous polyps.

Conclusions:

• Fecal occult blood testing is an effective tool for colon cancer screening and case finding.
• The simplicity, low cost, and availability of fecal occult blood testing make it a valuable screening method.
• Development of new human hemoglobin-specific tests could enhance the efficacy of this screening approach.