Preventing Chronic Disease | Comparison of Fecal Occult Blood Tests for Colorectal Cancer Screening in an Alaska Native Population With High Prevalence of Helicobacter pylori Infection, 2008–2012 - CDC
Comparison of Fecal Occult Blood Tests for Colorectal Cancer Screening in an Alaska Native Population With High Prevalence ofHelicobacter pylori Infection, 2008–2012
Diana Redwood, PhD, MPH; Ellen Provost, DO, MPH; Elvin Asay, MS; Diana Roberts, MS; Donald Haverkamp, MPH; David Perdue, MD, MSPH; Michael G. Bruce, MD, MPH; Frank Sacco, MD; David Espey, MD
Suggested citation for this article:
Redwood D, Provost E, Asay E, Roberts D, Haverkamp D, Perdue D, et al. Comparison of Fecal Occult Blood Tests for Colorectal Cancer Screening in an Alaska Native Population With High Prevalence of Helicobacter pylori Infection, 2008–2012. Prev Chronic Dis 2014;11:130281. DOI: http://dx.doi.org/10.5888/pcd11.130281
Alaska Native colorectal cancer (CRC) incidence and mortality rates are the highest of any ethnic/racial group in the United States. CRC screening using guaiac-based fecal occult blood tests (gFOBT) are not recommended for Alaska Native people because of false-positive results associated with a high prevalence of Helicobacter pylori-associated hemorrhagic gastritis. This study evaluated whether the newer immunochemical FOBT (iFOBT) resulted in a lower false-positive rate and higher specificity for detecting advanced colorectal neoplasia than gFOBT in a population with elevated prevalence of H. pyloriinfection.
We used a population-based sample of 304 asymptomatic Alaska Native adults aged 40 years or older undergoing screening or surveillance colonoscopy (April 2008–January 2012).
Specificity differed significantly (P < .001) between gFOBT (76%; 95% CI, 71%–81%) and iFOBT (92%; 95% CI, 89%–96%). Among H. pylori-positive participants (54%), specificity of iFOBT was even higher (93% vs 69%). Overall, sensitivity did not differ significantly (P = .73) between gFOBT (29%) and iFOBT (36%). Positive predictive value was 11% for gFOBT and 32% for iFOBT.
The iFOBT had a significantly higher specificity than gFOBT, especially in participants with current H. pylori infection. The iFOBT represents a potential strategy for expanding CRC screening among Alaska Native and other populations with elevated prevalence of H. pylori, especially where access to screening endoscopy is limited.
Corresponding Author: Diana Redwood, MS, MPH, 4000 Ambassador Dr, C-DCHS, Anchorage, AK 99508. Telephone 907-729-3959. E-mail:email@example.com
Author Affiliations: Ellen Provost, Elvin Asay, Frank Sacco, Alaska Native Tribal Health Consortium, Anchorage, Alaska; Diana Roberts, Donald Haverkamp, David Espey, Centers for Disease Control and Prevention, Albuquerque, New Mexico; David Perdue, American Indian Cancer Foundation and Minnesota Gastroenterology PA, Minneapolis, Minnesota; Michael G. Bruce, Centers for Disease Control and Prevention, Anchorage, Alaska.
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