Screening for colorectal neoplastic lesions in Israeli kibbutz members using a combination of flexible sigmoidoscopy and fecal occult blood testing

Recent data suggest that a combination of flexible sigmoidoscopy and fecal occult blood testing provides the most effective screening for colorectal cancer. We used this combination to screen Israeli kibbutz (communal settlement) members. Methods: Four hundred and forty-six persons over 40 years of age were invited to participate in a colorectal cancer screening program. They were asked to complete a questionnaire for detecting high-risk groups and undergo fecal occult blood testing and flexible sigmoidoscopy. Results: Two-hundred twenty-eight members participated in the study, a compliance of 51.1%. The fecal occult blood test was positive in 4 screenees (1.76%) All of them underwent colonoscopy but no neoplastic lesion was found. Eight neoplastic lesions were found in 8 other screenees (3.50%). In 5 patients the adenomas were more than 1 cm in diameter, and carcinoma was found in one screenee (Duke B2). Stratification of the screenees with adenomatous polyps according to age demonstrated a gradual increase from 1.29% to 2.98% and 4.05% in age groups 40-49, 50-59 and 60-69 years, respectively. Adenomatous polyps were found in 5.19% of 77 screenees with at least one first degree relative with epithelial cancer but in only 2.65% of 151 without a family history but this did not reach statistical significance. Conclusions: In this population, flexible sigmoidoscopy detected lesions in patients which would not have been found on the basis of occult blood positivity. Fecal occult blood testing had zero sensitivity but 98.4% specificity. The more flexible sigmoidoscopies are performed, the more polyps and cancer will be found and cost is the main limitation for a nation-wide colorectal screening program.