Effect of faecal occult blood screening on mortality from colorectal cancer: results from a randomised controlled trial

Abstract

Background: Three large randomised trials have shown that screening for colorectal cancer using faecal occult blood (FOB) tests can reduce the mortality from this disease. Two national pilot studies have recently been launched in the UK to investigate the feasibility of population screening for colorectal cancer in the National Health Service. The largest of the randomised trials was conducted in Nottingham and randomised 152 850 individuals between the ages of 45 and 74 years to receive biennial Haemoccult (FOB) test kit (intervention group) or to a control group. Aims: We have compared the mortality in the intervention group compared with the control group. Methods: The 152 850 randomised individuals were followed up through local health records and central flagging (Office for National Statistics) over a median follow up period of 11 years. Results: At a median follow up of 11 years there was a 13% reduction in colorectal cancer mortality (95% confidence interval 3-22%) in the intervention group despite an uptake at first invitation of only approximately 50%. The mortality reduction for those accepting screening was 27%. The reduction in mortality was independent of sex and site of tumour. There was no significant difference in mortality from causes other than colorectal cancer between the intervention and control groups. Conclusions: Although the reduction in colorectal cancer mortality was sustained, further follow up of this population is required to determine whether a significant reduction in the incidence of colorectal cancer will be achieved.

Evaluation of bowel cancer registration data in England, 1996–2004

“…However, there is no indication so far from the Nottingham RCT, whose protocol the screening programme follows, that such a reduction will be observed (Scholefield et al, 2002) and any reduction is likely to take around 15 -20 years.…”

MicroRNA Expression Profiling of Exfoliated Colonocytes Isolated from Feces for Colorectal Cancer Screening

“…Thus, to reduce the mortality rate of CRC, it is necessary to develop a screening test by which the cancer can be diagnosed at an early stage. To date, the fecal occult blood test has been widely used as the main screening test for CRC (2)(3)(4). However, largescale studies have shown that the sensitivity of fecal occult blood test is not very high, using total colonoscopy as a reference standard in all subjects (5)(6)(7)(8).…”

Factors that contribute to faecal cyclooxygenase-2 mRNA expression in subjects with colorectal cancer

“…The introduction of FOBT in CRC screening reduced the morbidity and mortality associated with CRC (Mandel et al, 1993;Hardcastle et al, 1996;Scholefield et al, 2002;Lindholm et al, 2008). However, FOBT is less sensitive for detecting proximal CRC lesions and small lesions (Morikawa et al, 2005).…”

“…Effective screening to detect cancer is expected to reduce the mortality rate of CRC (Mandel et al, 1993;Hardcastle et al, 1996;Scholefield et al, 2002;Lindholm et al, 2008). Faecal occult blood test (FOBT) is a non-invasive and simple test reported to reduce the morbidity and mortality associated with CRC (Mandel et al, 1993;Hardcastle et al, 1996;Scholefield et al, 2002;Lindholm et al, 2008).…”