Emily Clark conducted an internship to compare two fecal immunochemical tests (FIT) used for colorectal cancer screening - the Hemocult ICT and OC-Auto FIT. Data was analyzed from screenings at Cooper University Hospital from 2013-2016, when both tests were used but OC-Auto FIT was implemented in 2014. After switching to OC-Auto FIT, there was a 9% increase in returned tests, a 35% decrease in positive results, and an 11% increase in negative results. Overall, OC-Auto FIT was found to be more effective for the cancer screening project due to greater patient convenience and compliance, as evidenced by more completed and returned tests.

1. Internship Abstract
Title: Colorectal Cancer Detection Test Superiority Determination
Name: Emily Clark
Preceptor: Evelyn Robles-Rodriguez, Director
Agency: Cooper University Hospital, Camden, NJ
Purpose: To compare the Hemocult ICT versus the OC-Auto Fecal immunochemical tests (FIT) as part
of the colorectal screening process through evaluation of collected data and further research.
Significance: Colorectal cancer is the second leading cause of cancer-related deaths in the United States.
In the past few decades, the death rate due to colorectal cancer has been decreasing for both men and
women. This can be attributed to proficient screening techniques which find polyps before they become
cancerous or when they are in the earlier stages of the disease (Key...). It is therefore important to have
the most effective screening technology in place when screening for colorectal cancer. The FIT assays are
part of the one or two-step process (depending on the need for a colonoscopy) presently used to screen for
colorectal cancer (Smith). This study will provide data to support the claim that OC-Auto FIT assay,
currently used by the Camden County Cancer Screening Project at Cooper University Hospital, is more
effective than the Hemocult ICT FIT test, which was formerly used by the screening project, in screening
for colorectal cancer. This evidence-based evaluation of the two tests could be used to prove the need for
the FIT kits as an essential part of the cancer screening process at The Camden County Cancer Screening
Project and cancer screening programs alike.
Method: This study used data collected from colorectal cancer screenings Cancer Screening Project at
Cooper University Hospital from July 2013 to June 2016 from the Camden, NJ area. During this time
span, both the Hemocult ICT and OC-Auto FIT assays were used, with the implementation of the latter on
November 21, 2014. The Camden County Cancer Screening Project at Cooper University Hospital
administers free colorectal screening by providing patients with a colorectal screening kit during an
office visit and relying on the patient to complete the kit at home. The fulfillment of the kit is contingent
upon a bowel movement and the timely return of a swab of the specimen via the mail in a pre-stamped
envelope which is sent directly to a lab for analysis. To note, the Hemocult ICT assay requires that the
patient take stool samples from bowel movements from two days while following a restricted diet and
medication intake. The OC-Auto FIT works similarly, however, the samples are only collected over a
one-day period and the test does not impose restrictions on food or drugs. A positive test result indicates
the presence of blood in the stool which could indicate cancer or precancer in the colon or rectum
(Tests..). The patient is then referred for a colonoscopy which is often covered by charity care. The
values from both FIT assays were contrasted, and the data was discussed with members of The Cancer
Screening Project to determine the implications of the values.
Outcomes: After switching to the OC-Auto FIT assay, there was an overall 9% increase in the number of
returned colorectal screening tests. A 35% decrease in the number of positive test results was observed in

2. Internship Abstract
the OC-Auto FIT assays as compared to that of the Hemocult ICT tests. There was also an 11% increase
in the negative test results after the switch.
Evaluation: Overall, the OC-Auto FIT assay was overall found to be more effective in testing for
colorectal cancer than the Hemocult ICT FIT for the Camden County Cancer Screening Project. There
was an overall change in sensitivity observed which can be accounted for by the decrease in the number
of positive test results which could be explained by a decrease in false positives proving the test more
sensitive, or by a decrease in true positives meaning the test was less sensitive. The OC-Auto FIT also
achieved a higher negative result rate, which can imply increased sensitivity and therefore less false
positives, or a decrease in sensitivity by the inability to detect blood in the stool. However, this study
cannot measure true sensitivity as not all patients received colonoscopies following the screening to
confirm the results of the screening tests. Most importantly for the cancer screening project, the OC-Auto
FIT assays are correlated with an the number kits that are completed and returned to the lab for
evaluation. This is primarily due to the convenience of the OC-Auto FIT assay versus the original
Hemocult ICT for the patient. This increase is an important factor in reducing the incidence of colorectal
cancers.