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FOB Testing May Save Lives, but Is It Accepted?

Professional groups differ in their recommendations for fecal occult blood (FOB) testing to screen for colorectal cancer. One source of disagreement is the lack of substantial evidence that testing reduces mortality. Two randomized trials now offer such evidence.

In the first, 30,967 people in one Danish city, aged 45 to 75, were offered FOB testing five times in 10 years; 20,672 (67%) actually had at least one screening, which involved a Hemoccult II test (mailed as a kit) and dietary restriction. A control group of 30,966 continued their usual care. During the 10 years, 481 members of the screening group were diagnosed with colorectal cancer, and 205 died from it; controls had 483 diagnoses and 249 deaths. The mortality ratio was 0.82, a reduction of 18% with biennial screening.

A 10-year British study randomized about 150,000 people aged 45 to 74 to biennial Hemoccult screening or to a control group. Forty percent of the screening group refused screening, and only 38% completed all FOB tests offered. There were 360 colorectal cancer deaths in the screening group and 420 among controls, representing a 15% mortality reduction.

Comment: These intention-to-treat analyses support FOB screening. But cost-benefit and acceptability questions need to be considered before implementing mass screening. In the British study, less than half the screening group completed all tests; acceptance was higher in Denmark, but this population is less similar to that of the U.S. Improving acceptability might increase the test's relatively modest effect on mortality.

— DE Judge

Published in Journal Watch Women's Health January 1, 1997

Citation(s):

Kronborg O et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996 Nov 30 348 1467-1471.

• Medline abstract (Free)

Hardcastle JD et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996 Nov 30 348 1472-1477.

• Medline abstract (Free)