Screening

^^ Health care professionals must be aware of and promote appropriate screening recommendations for colorectal cancer in their patients. Effective screening programs incorporate fecal occult blood tests (FOBTs) and regular examinations. Appropriate screening of patients at normal and high risk for colorectal cancer leads to the detection of smaller, localized lesions and higher cure rates.18 Screening techniques include a digital rectal exam, FOBTs, and imaging of the colon. The use of FOBTs annually in combination with digital rectal exams has led to earlier diagnosis of early stages of disease and may reduce colorectal cancer mortality by up to one-third.18 Two main methods are available to detect occult blood in the feces: guaiac dye and immunochemical methods. The Hemoccult II is the most commonly used FOBT in the United States and is a guaiac-based test. Proper counseling by health care providers is required to receive accurate test results. Table 91-2 lists common reasons for inaccurate results with the guaiac tests and requires appropriate counseling on the use of these tests. Fecal immunochemical tests (FIT) (InSure, and others), which use antibodies to detect hemoglobin, are also available for use. One advantage of immunochemical tests is that they do not react with dietary factors or medications. Both FOBTs can be recommended in screening protocols for patients.

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