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RESEARCH PRODUCT

Faecal immunochemical tests: A valuable tool for colorectal cancer screening

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Colorectal cancer is a major health problem in industrialized ountries and fulfils the conditions required to justifymass screenng of the general population. Population-based controlled studies erformed in Europe have shown that guaiac faecal occult blood esting (G-FOBT) followed by colonoscopy to detect the cause of leeding can reduce colorectal cancer mortality [1]. Nearly all pubished studies evaluated the Hemoccult II (Beckman Coulter Inc., ea, USA) faecal occult blood test. Screening for colorectal caner using FOBT has, therefore, been included in the European Code gainst Cancer and has been endorsed by the European Commision [2]. Despite its high specificity, Hemoccult has been criticized or its fairly low sensitivity and because it reacts with non-human aeme in food. For these reasons, attention has been given to alterative screening strategies, in particular, immunochemical faecal ccult blood testing (I-FOBT). Accurate interpretation of G-FOBTs is not easy and requireswell stablished laboratories. The development of quantitative I-FOBTs nd of automated systems for the interpretation of the screening esthas increased interest in I-FOBTs, as theyminimisehumanerror n test processing and allow excellent quality control. One limit of -FOBTswas that globin (themeasured component of haemoglobin n these tests) was not stable in the buffer and was prone to denatration. Manufacturers have now modified the buffer to increase lobin stability. None of the quantitative I-FOBT appeared to be learly better than the others [3]. Moreover improved standardiation is necessary so that the tests can be compared directly. To ate, there are no internationally agreed standards. In the current issue of Digestive and Liver Disease, two separate tudies provide comparisons of the performance of Hemoccult II ith that of three different available I-FOBTs. The results are of nterest in that they concern subjects attending subsequent screenng rounds, while most studies have reported data concerning the revalent round. Faivre at al. [4] have added to our understanding of colorectal ancer screening using I-FOBT. The study provides a direct comarison of the performance of Hemoccult II given with one of the wo studied immunochemical quantitative tests OC-Sensor (Eiken,