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Workplace based faecal occult blood screening

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Population screening using faecal occult blood tests may increase the rate of detection of early stage colorectal tumours and reductions in mortality of 15%, 18%, and 33% have been shown in three large studies. Screening programmes based on general practices have had low rates of acceptance. It has been suggested that on-site health education might increase compliance rates in workplace based programmes, but a study at a large engineering company in the East Midlands, UK has also shown disappointing rates of compliance.

During 1992–93 a total of 1828 employees aged 41–65 were sent a letter explaining the study and inviting them to participate. Posters were put up at the site and the firm’s medical department answered enquiries. Employees who agreed were sent a Haemoccult pack to provide samples for testing on three separate days. Positive tests were repeated after dietary restrictions (no red meat, black pudding, cauliflower, cabbage, spinach, radishes, parsnip, broccoli, or bananas) and, if still positive colonoscopy was offered. In all, 465 employees (25.4%) completed three Haemoccult tests. The rate of compliance was not significantly different between men (425/1703) and women (40/125). Men aged 51–60 were more likely to comply than men aged 41–50 or 61–65. Among women compliance rates were similar at ages 41–50 and 51–60. There were only seven women aged 61–65 and none of them completed a series of occult blood tests. Compliance was better among managers (28.6%) than non-managers (23.5%) especially in the youngest age group (41–50).

Four occult blood series (0.9%) gave a positive result and one remained positive after dietary restriction. This positive test led to the discovery of a 1 cm pedunculated polyp in the splenic flexure. After colonoscopic removal the tumour proved to be a tubular adenoma with mild dysplasia and complete excision margins. The financial cost of screening in 1993 was £6180 (testing kits £580, staff costs £5000, colonoscopy £600).

The uptake of screening in this company based programme was low and similar to that achieved in some general practice studies. More intense presentation of the case for screening might increase uptake but older and non-managerial employees might be the least likely to consent.