1. The Importance of Stool Occult Blood Tests in Getting to 80% Durado Brooks, MD, MPH Director, Cancer Control Interventions American Cancer Society

2. Stool Occult Blood Tests Look for hidden blood in stool. Two major types –Guaiac –Immunochemical (FIT) Multiple brands (all are not created equal)

3. Efficacy

5. Accuracy

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8. Preferences

9. Patient Preferences Inadomi, Arch Intern Med 2012

10. Many Patients Prefer Stool Tests  Diverse sample of 323 adults given detailed side-by-side description of FOBT and colonoscopy (DeBourcy et al. 2007)  53% preferred FOBT  Almost half felt very strongly about their preference  212 patients at 4 health centers rated different screening options with different attributes (Hawley et al. 2008)  37% preferred colonoscopy  31% preferred FOBT  Nationally representative sample of 2068 VA patients given brief descriptions of each screening mode (Powell et al. 2009)  37% preferred colonoscopy  29% preferred FOBT

11. Quality

12. Stool Testing Quality Issues In-office FOBT is essentially worthless as a screening tool for CRC and should never be used. CRC screening by FOBT should be performed with high-sensitivity FOBT - either FIT or a highly sensitive gFOBT (such as Hemoccult SENSA). – Older, less sensitive guiaic tests (such as Hemoccult II) should not be used for CRC screening. Annual testing All positive screening tests should be evaluated by colonoscopy

13. Clinicians Reference: FOBT One page document designed to educate clinicians about important elements of colorectal cancer screening using fecal occult blood tests (FOBT). Provides state-of-the-science information about guaiac and immunochemical FOBT, test performance and characteristics of high quality screening programs. Available at www.cancer.org/colonmd www.cancer.org/colonmd High Quality Stool Testing

14. Evidence Based Interventions

15.  Standing orders  Patient reminders  Mailed outreach  FluFIT/FluFOBT

16. What is a FluFIT program?  Takes advantage of patient awareness and desire for annual flu shots by using existing outreach and in-reach efforts to offer CRC screening.  Practice staff recommend CRC screening and provide FOBT kits to eligible patients when they get their annual flu shot  Either a high sensitivity FOBT or a FIT can be used  Patient completes FOBT at home and returns kit to doctor’s office or mails kit to the lab for processing

17. CRC Screening Outreach During Annual Flu Shot Activities  Potential Benefits of “Flu-FOBT” or “Flu-FIT” Programs:  Reaches patients at a time each year when they are already thinking about prevention  Creates a seasonal focus on cancer screening that may add to other screening efforts  Time-efficient way to involve non-physician staff in screening activities  Educates patients that “just like a flu shot, you need FOBT/FIT every year” Slide courtesy of M. Potter, MD

18. Stool Occult Blood Testing Health systems must: Understand the importance of providing patients with screening options Educate clinicians Pick a high sensitivity guaiac or FIT Ensure that stool testing programs address important quality elements