Early detection of bowel cancer in occupational surveillance examinations: Switching from a guaiak-based to an immunochemical fecal occult blood test [Darmkrebsfrüherkennung im betriebs?rztlichen Umfeld: Umstellung vom Guajak-basierten auf einen immunologischen Test auf okkultes Blut im Stuhl]

摘要

Background: If the diagnosis is made early the cure rate of bowel cancer is more than 90%. Occupational preventative medical care required by law and carried out by company physicians can be supplemented by a medical consultation and by simple screenings to interest employees in cancer prevention and refer them to registered general practitioners and specialist doctors for further diagnosis and treatment. Subjects and methods: Since 2001, BASF SE in Ludwigshafen, Germany offers its employees aged 45 and more a program to detect intestinal cancer early. The employees receive personal invitations for this program once a year. The participants answer a standard questionnaire about risk factors for bowel cancer and an endoscopic diagnosis, if this has already been carried out, and receive a FOBT. Since 2010 an immunological test system was used. We compare the results from two consecutive years with a Guajacum test system (g-FOBT) and an immunological test (i-FOBT). The German Association of Digestive and Metabolic Diseases, DGVS, recommends a colonoscopy if test results are positive or a family member has suffered from bowel cancer. Results: Between 2008 and 2011, a total of 52,797 invitations were sent to employees aged 45 and over. Overall, 16,730 men (37.7% of 46,245) and 1,585 women (24.4% of 6,552) took part (in some cases more than once). The return rate of the FOBT increased from 66.7% in 2008 to 79.5% in 2011. Due to positive results and/or suspicious information in the questionnaire, 2,441 colonoscopies were recommended, 849 of them because of a positive FOBT. The medical department was informed of 224 endoscopy diagnoses. In 8 cases, manifested cancer (6 × colon, 2 × rectum) and in 57 cases adenomatous polyps were diagnosed as preliminary stages of cancer. Most of these diagnoses were made using the i-FOBT, the simultaneous increase in positive test results and therefore more frequent recommendations for a colonoscopy. Conclusion: The additional offer of a program for early detection of bowel cancer as part of an occupational surveillance examination helps detecting bowel cancer early in employees who show no symptoms. Since men on average fall ill earlier, it makes sense to offer these tests at the age of 45. Personal invitations lead to consistently high participant rates and the simplicity of the i-FOBT leads to high return rates of tests. The rate of positive test results is higher compared to g-FOBT. In our follow-up, significantly more intestinal cancer and possible preliminary stages were detected through screening with the immunological test.