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Home testing for cancer
Newsdesk
Home testing for cancer government-organised scheme, such as that planned in the UK, or whether it is opportunistic, eg, through purchase of over-the-counter test kits. FOBT kits are sold in pharmacies in Australia, and Glenn Salkeld, School of Public Health, University of Sydney, Australia, says that the information provided on the process of home testing is adequate, “but information on the downsides of screening is inadequate . . . quantative information on the risk of false positive and false negatives is virtually nonexistent”. Testing should be appropriate, as highlighted by the example of prostatespecific antigen (PSA) tests, which can be bought for use at home. Peter Albertsen, University of Connecticut, Farmington, CT, USA, warns that “since the role of PSA as a screening test is still controversial, that same controversy would extend to home testing. In fact, it could compound the problem. Repeated testing for PSA enhances the probability of finding less aggressive and potentially indolent disease”. For any screening programme, procedures for follow-up must be in place. Access to follow-up will depend in part on the way the test result is delivered. Ole Kronborg, Odense University Hospital, Denmark, says that “test results should be communicated to the screenees regardless of result, and the written communication should be followed by an oral communication to those with positive tests telling them how to obtain a colonoscopy”. The health service must also be ready to cope with the increased demand for colonoscopy. Robert Steele (Ninewells Hospital, Dundee, UK) warns that “screen-positive individuals should not take precedence over symptomatic patients and the intention in the UK is to roll out screening at a pace that is commensurate with the ability to improve endoscopy services across the country”. Robin Teague, Chairman, British Society of Gastroenterologists Endoscopy Committee, says that the UK will “need
http://oncology.thelancet.com Vol 6 September 2005
to recruit approximately 250 expert colonoscopists over a 2–3-year period”. A test’s sensitivity and specificity is important. Anne Miles and colleagues (University College London, UK) have shown that organised screening programmes do not always offer the most sensitive screening test for a particular cancer, but participants receive greater protection from the harmful effects of screening (ie, false positives), and more of the population is covered. Kronborg agrees: “The guaiac tests used for FOBT at home are cheap, simple, without any risk and very specific (identifying 99% correctly among those without cancer), but you would like a higher sensitivity for cancer”. However, he cautions, “do not forget that we are talking about a programme (annual or biennial tests) and not the sensitivity of a single test at one time”. He continues “to my mind opportunistic screening is of very limited value to society, but may satisfy an unknown number of individuals who can afford it”. However, the future of home testing as part of a nationally organised screening campaign remains to be seen. In the meantime, says Kronborg, it is more appealing “because it makes it possible to ascertain quality control and thereby get most value for the taxpayers money”.
See http://cancerscreening.nhs.uk
Cancer 2004; 101 (suppl 5): 1201–13
Lidia Siemaszkiewicz
© Steve Schmeissner/Science Photo Library
In August, 2005, UK Health Minister Rosie Winterton announced the launch of a national programme for bowelcancer screening to be phased in from April, 2006, in which men and women aged 60–69 years will be invited to take part in screening every 2 years by use of a faecal occult blood test (FOBT) done at home and then sent for laboratory analysis. But how effective is home testing as a means of screening for cancer? The first-round evaluation by the UK Department-of-Health to assess the uptake of FOBT suggests that about 60% of the eligible population would undertake home testing, according to Sheina Orbell, University of Essex, UK. “For the most part, people are likely to welcome the opportunity to take part in this screening programme”, she says. However, the pilot study showed variations in uptake by sex, ethnic origin, and geographical region. Furthermore, people might not complete the test because of concern that they might do it incorrectly. Regarding the home FOBT, Orbell says, “evidence suggests that confidence in actually completing the test kit was a factor in distinguishing people who did or did not return their samples”. Jane Wardle, Director, Cancer Research UK Health Behaviour Unit, University College London, UK, has investigated attitudes towards cervical self-sampling for human papillomavirus, and agrees that patients can be concerned about doing a procedure correctly. “When British women use self-sampling, they express concerns about their competence to do the test and worry that problems could be missed.” However, women did see some advantages to self-sampling—eg, they described it as “less uncomfortable and less embarrassing”. But does self-testing mean that the patient misses out on important interactions with their health practitioner, such as counselling about the test, the disease, and the implications of positive and negative results? Much depends on whether home testing is part of a
Testing for colon cancer could be done in the home
639
Home testing for cancer government-organised scheme, such as that planned in the UK, or whether it is opportunistic, eg, through purchase of over-the-counter test kits. FOBT kits are sold in pharmacies in Australia, and Glenn Salkeld, School of Public Health, University of Sydney, Australia, says that the information provided on the process of home testing is adequate, “but information on the downsides of screening is inadequate . . . quantative information on the risk of false positive and false negatives is virtually nonexistent”. Testing should be appropriate, as highlighted by the example of prostatespecific antigen (PSA) tests, which can be bought for use at home. Peter Albertsen, University of Connecticut, Farmington, CT, USA, warns that “since the role of PSA as a screening test is still controversial, that same controversy would extend to home testing. In fact, it could compound the problem. Repeated testing for PSA enhances the probability of finding less aggressive and potentially indolent disease”. For any screening programme, procedures for follow-up must be in place. Access to follow-up will depend in part on the way the test result is delivered. Ole Kronborg, Odense University Hospital, Denmark, says that “test results should be communicated to the screenees regardless of result, and the written communication should be followed by an oral communication to those with positive tests telling them how to obtain a colonoscopy”. The health service must also be ready to cope with the increased demand for colonoscopy. Robert Steele (Ninewells Hospital, Dundee, UK) warns that “screen-positive individuals should not take precedence over symptomatic patients and the intention in the UK is to roll out screening at a pace that is commensurate with the ability to improve endoscopy services across the country”. Robin Teague, Chairman, British Society of Gastroenterologists Endoscopy Committee, says that the UK will “need
http://oncology.thelancet.com Vol 6 September 2005
to recruit approximately 250 expert colonoscopists over a 2–3-year period”. A test’s sensitivity and specificity is important. Anne Miles and colleagues (University College London, UK) have shown that organised screening programmes do not always offer the most sensitive screening test for a particular cancer, but participants receive greater protection from the harmful effects of screening (ie, false positives), and more of the population is covered. Kronborg agrees: “The guaiac tests used for FOBT at home are cheap, simple, without any risk and very specific (identifying 99% correctly among those without cancer), but you would like a higher sensitivity for cancer”. However, he cautions, “do not forget that we are talking about a programme (annual or biennial tests) and not the sensitivity of a single test at one time”. He continues “to my mind opportunistic screening is of very limited value to society, but may satisfy an unknown number of individuals who can afford it”. However, the future of home testing as part of a nationally organised screening campaign remains to be seen. In the meantime, says Kronborg, it is more appealing “because it makes it possible to ascertain quality control and thereby get most value for the taxpayers money”.
See http://cancerscreening.nhs.uk
Cancer 2004; 101 (suppl 5): 1201–13
Lidia Siemaszkiewicz
© Steve Schmeissner/Science Photo Library
In August, 2005, UK Health Minister Rosie Winterton announced the launch of a national programme for bowelcancer screening to be phased in from April, 2006, in which men and women aged 60–69 years will be invited to take part in screening every 2 years by use of a faecal occult blood test (FOBT) done at home and then sent for laboratory analysis. But how effective is home testing as a means of screening for cancer? The first-round evaluation by the UK Department-of-Health to assess the uptake of FOBT suggests that about 60% of the eligible population would undertake home testing, according to Sheina Orbell, University of Essex, UK. “For the most part, people are likely to welcome the opportunity to take part in this screening programme”, she says. However, the pilot study showed variations in uptake by sex, ethnic origin, and geographical region. Furthermore, people might not complete the test because of concern that they might do it incorrectly. Regarding the home FOBT, Orbell says, “evidence suggests that confidence in actually completing the test kit was a factor in distinguishing people who did or did not return their samples”. Jane Wardle, Director, Cancer Research UK Health Behaviour Unit, University College London, UK, has investigated attitudes towards cervical self-sampling for human papillomavirus, and agrees that patients can be concerned about doing a procedure correctly. “When British women use self-sampling, they express concerns about their competence to do the test and worry that problems could be missed.” However, women did see some advantages to self-sampling—eg, they described it as “less uncomfortable and less embarrassing”. But does self-testing mean that the patient misses out on important interactions with their health practitioner, such as counselling about the test, the disease, and the implications of positive and negative results? Much depends on whether home testing is part of a
Testing for colon cancer could be done in the home
639