Assessing the diagnostic performance of faecal occult blood testing, against colonoscopy, in people at elevated risk for bowel cancer.

Colorectal cancer (CRC) prevention programs are tailored to the degree of risk and within the Australian public health system with surveillance by colonoscopy usually reserved for those in the above average risk category. Different levels of risk, average, moderately increased and high, are recognised for population sub-groups. People with known genetic syndromes (eg familial adenomatous polyposis [FAP], hereditary nonpolyposis colorectal cancer [HNPCC, also known as Lynch Syndrome] are considered to be at high risk for CRC and are advised to undergo regular (every 1-2 years) colonoscopic surveillance. We propose to conduct this uncontrolled observational study, where patients self-select to the treatment group based on their participation in a colonoscopy surveillance program - the 'Southern Cooperative Program for the prevention of colorectal cancer' (SCOOP), run through Flinders Medical Centre and Noarlunga Hosptial. We will approach SCOOP patients and offer a FIT (Faecal Occult Blood Test) to be completed 1 - 2 weeks prior to their scheduled colonoscopy to determine the positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity for neoplasia of FIT, in comparison to colonoscopy. The FIT kit including an invitation letter, two collection tubes, instructions and a reply paid envelope, will be posted to study invitees. Participants will be required to self-collect two small stool samples (approximately 10mg of stool which is smaller than a grain of rice) with the provided collection devices. The samples will then be placed in the collection tubes, placed in a reply paid envelope and posted back to the testing laboratory. Following return to the testing laboratory, samples will be analysed for levels of faecal haemoglobin. Testing will be within the Bowel Health Service Laboratory of Flinders Centre for Innovation in Cancer. The screening process is unlikely to lead to adverse medical events requiring contingency planning. Some participants may require further information or guidance through the testing process. The Bowel Health Service operates a business hours Help-Line to respond to any patient inquiries in relation to the study, eg the collection and return of specimens. Faecal haemoglobin results will be compared to outcomes at colonoscopy which will allow for calculation of FIT accuracy for neoplasia detection.