Digestive Diseases and Sciences

, Volume 63, Issue 10, pp 2780–2785 | Cite as

Screening Women Aged 50–59 for CRC Using Fecal Occult Blood Test Produces Outcomes Similar to Men Undergoing Screening Colonoscopy

  • Harrison M. Mooers
  • Jennifer L. Holub
  • David A. LiebermanEmail author
Original Article



Average-risk women aged 50–59 years have a lower incidence and mortality of colorectal cancer relative to age-matched men, calling into question the benefit of screening colonoscopy in this age group.


We aimed to determine whether FOBT is an effective initial screening test in 50–59-year-old women.


We conducted a cross-sectional study using a computerized endoscopic report generator. We identified 320,906 individuals who had average-risk screening colonoscopy and 32,369 who had colonoscopy for positive FOBT. The primary outcome was the positive predictive value (PPV) of FOBT for large polyp(s) greater than 9 mm, as a surrogate for advanced neoplasia.


Among patients aged 50–59 years undergoing screening colonoscopy, men were more likely than women to have large polyps (6.3 vs 4.2%, p < 0.0001). Black women undergoing screening colonoscopy had higher rates of large polyps compared to non-Black women. The PPV in FOBT-positive men aged 50–54 (11.5%) and 55–59 (14.4%) was higher than in women aged 50–54 (6.1%) and 55–59 (5.4%). Despite this lower PPV, women aged 50–54 with a positive FOBT had a similar rate of large polyps as 50–54-year-old men undergoing screening colonoscopy (6.1 vs 6.3%, p = 0.626).


CRC screening with FOBT identifies 50–59-year-old men and women with a higher risk of large polyps. Since younger women have a lower risk of large polyps than men, screening with FOBT in 50–59-year-old non-Black women could be an effective screening strategy, with outcomes similar to the use of screening colonoscopy in 50–59-year-old men.


Colon cancer Screening Polyps FOBT Women 



This project was supported with funding from NIDDK U01DK57132 and R33-DK61778-01. In addition, the practice network (Clinical Outcomes Research Initiative) has received support from the following entities to support the infrastructure of the practice-based network: AstraZeneca, Novartis, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. The commercial entities had no involvement in this research.

Compliance with ethical standards

Conflict of interest

Dr. Lieberman is the executive director of CORI, a non-profit organization that receives funding from federal and industry sources. This potential conflict of interest has been reviewed and managed by the OHSU and Portland VA Conflict of Interest in Research Committees. All other authors have no potential conflicts of interests to disclose.


  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2016;66:7–30.CrossRefPubMedGoogle Scholar
  2. 2.
    American Cancer Society. Cancer Facts and Figures 2016. Accessed January 1, 2016.
  3. 3.
    Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–1595.CrossRefPubMedGoogle Scholar
  4. 4.
    Rex DK, Johnson DA, Anderson JC, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol. 2009;104:739–750.CrossRefPubMedGoogle Scholar
  5. 5.
    Qaseem A, Denberg TD, Hopkins RH Jr, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156:378–386.CrossRefPubMedGoogle Scholar
  6. 6.
    US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Screening for colorectal cancer: US preventive services task force recommendation statement. JAMA. 2016;315:2564–2575.CrossRefGoogle Scholar
  7. 7.
    Klabunde CN, Joseph DA, King JB, et al. Vital signs: colorectal cancer screening test use—United States, 2012. MMWR Morb Mortal Wkly Rep. 2013;62:881–888.PubMedCentralGoogle Scholar
  8. 8.
    Shapiro JA, Klabunde CN, Thompson TD, et al. Patterns of colorectal cancer test use, including CT colonography, in the 2010 National Health Interview Survey. Cancer Epidemiol Biomark Prev. 2012;21:895–904.CrossRefGoogle Scholar
  9. 9.
    SEER*Explorer. National Cancer Institute. Updated April 14, 2017. Accessed April 23, 2017.
  10. 10.
    Regula J, Rupinski M, Kraszewska E, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006;355:1863–1872.CrossRefPubMedGoogle Scholar
  11. 11.
    Schoenfeld P, Cash B, Flood A, et al. Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med. 2005;352:2061–2068.CrossRefPubMedGoogle Scholar
  12. 12.
    Lieberman DA, Williams JL, Holub JL, et al. Race, ethnicity, and sex affect risk for polyps > 9 mm in average-risk individuals. Gastroenterology. 2014;147:351–358.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ferlitsch M, Reinhart K, Pramhas S, et al. Sex-specific prevalence of adenomas, advanced adenomas and colorectal cancer in individuals undergoing screening colonoscopy. JAMA. 2011;306:1352–1358.CrossRefPubMedGoogle Scholar
  14. 14.
    Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328:1365–1371.CrossRefPubMedGoogle Scholar
  15. 15.
    Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–1477.CrossRefPubMedGoogle Scholar
  16. 16.
    Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–1471.CrossRefPubMedGoogle Scholar
  17. 17.
    Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993;329:1977–1981.CrossRefPubMedGoogle Scholar
  18. 18.
    Sonnenberg A, Amorosi SL, Lacey MJ, et al. Patterns of endoscopy in the United States: analysis of data from the Centers for Medicare and Medicaid Services and the National Endoscopic Database. Gastrointest Endosc. 2008;67:489–496.CrossRefPubMedGoogle Scholar
  19. 19.
    Lieberman D, Moravec M, Holub J, et al. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT Colonography. Gastroenterology. 2008;135:1100–1105.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lieberman DA, Holub JL, Moravec MD, et al. Prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients. JAMA. 2008;300:1417–1422.CrossRefPubMedGoogle Scholar
  21. 21.
    Brenner H, Hoffmeister M, Birkner B, et al. Men with negative results of guaiac-based fecal occult blood test have higher prevalence of colorectal neoplasms than women with positive results. Int J Cancer. 2014;134:2927–2934.CrossRefPubMedGoogle Scholar
  22. 22.
    Ferlitsch M, Heinze G, Salzl P, et al. Sex is a stronger predictor of colorectal adenoma and advanced adenoma than fecal occult blood test. Med Oncol. 2014;31:151.CrossRefPubMedGoogle Scholar
  23. 23.
    Inadomi JM, Vijan S, Janz NK, et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med. 2012;172:575–582.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Auge J, Pellise M, Escudero JM, et al. Risk stratification for advanced colorectal neoplasia according to fecal hemoglobin concentration in a colorectal cancer screening program. Gastroenterology. 2014;147:628–636.CrossRefPubMedGoogle Scholar
  25. 25.
    Van Hees F, Zauber AG, van Veldhuizen H, et al. The value of models in informing resource allocation in colorectal cancer screening—the case of the Netherlands. Gut. 2015;64:1985–1997.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Decker K, Demers A, Nugent Z, et al. Longitudinal rates of colon cancer screening use in Winnipeg, Canada: the experience of a universal health-care system with an organized colon screening program. Am J Gastroenterol. 2015;110:1640–1646.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Chan AT, Giovannucci EL. Primary prevention of colorectal cancer. Gastroenterology. 2010;138:2029–2043.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Harrison M. Mooers
    • 1
  • Jennifer L. Holub
    • 1
  • David A. Lieberman
    • 1
    Email author
  1. 1.Division of Gastroenterology and HepatologyOregon Health and Science UniversityPortlandUSA

Personalised recommendations