[Faecal occult blood test for colorectal cancer screening: high quality for a good price]. / Ontlastingstest bevolkingsonderzoek darmkanker: goede kwaliteit tegen een goede prijs.

The Dutch National Institute for Public Health and the Environment (RIVM) awarded the immunochemical faecal occult blood test (IFOBT) to FOB Gold of Sentinel following a European call for tenders. The contract-awarding procedure included the application of quality knock-out criteria, which were met by two suppliers. The decisive factor was the best price/quality ratio. A recent review indicated that, at present, no single IFOBT is better than any other. The decision to opt for a test manufactured by a different supplier than was used in the previous screening pilots made it necessary to re-determine the cut-off value. This value has now been set (88 ng/ml) and is confirmed by a laboratory test. Colonoscopy-related capacity planning, as well as its diagnostic yield, depends on numerous factors; therefore, the RIVM is currently monitoring the referral percentage and number of adenomas detected and is collaborating on quality terms. Any necessary adjustments are to be made during the introduction of the screening test.

[Application of tumour markers in clinical practice]. / Toepassing van tumormarkers in de klinische praktijk.

Usefully requesting and applying serum tumour markers in diagnosis and treatment can be difficult. It should be noted that tumour markers are used for varying purposes: screening, diagnosis, staging and prognostic evaluation, detection of recurrence and treatment monitoring. Due to the poor sensitivity and specificity of current tumour markers, most are not suitable for screening an asymptomatic population. Further, the benefits of an improved prognosis by early detection should be weighed against a poorer quality of life and the cost of substantial over-diagnosis and over-treatment. Serum tumour markers are particularly applicable in treatment monitoring and detection of recurrence. Sometimes they can be used to support the diagnostic process and give useful prognostic information.