Skip to main content
PMC home page
Gut logoLink to Gut
. 1999 Oct;45(4):588–592. doi: 10.1136/gut.45.4.588

The risks of screening: data from the Nottingham randomised controlled trial of faecal occult blood screening for colorectal cancer

M Robinson 1, J Hardcastle 1, S Moss 1, S Amar 1, J Chamberlain 1, N Armitage 1, J Scholefield 1, C Mangham 1
PMCID: PMC1727686  PMID: 10486370

Abstract

AIMS—To determine the harm that ensues from faecal occult blood (FOB) screening for colorectal cancer.
METHODS—150 251 people were randomly allocated either to receive biennial Haemoccult FOB tests (n =75 253) or not to be contacted (n=74 998). Study group patients returning positive tests were offered colonic investigation; 1774 underwent complete investigation of the colon.
RESULTS—There was no significant difference in the stage at presentation of interval versus control group cancers. Survival in the interval cancer group was significantly prolonged compared with the control group. Sensitivity for colonoscopy or flexible sigmoidoscopy and double contrast barium enema (DCBE) was 96.7%. There were no complications of DCBE but seven (0.5%) complications of colonoscopy, of which six required surgical intervention. There were no colonoscopy related deaths. No patients without colorectal cancer died within 30 days of colonic investigation. Five patients died within 30 days of surgery for screen detected colorectal neoplasia and a further two died without having surgery. Six patients died after 30 days but within two years of surgery for screen detected benign adenomas or stage A cancers; in all cases the cause of death was not related to colorectal cancer.
CONCLUSIONS—There was investigation related morbidity but no mortality and little to support overdiagnosis bias. The group returning falsely negative tests had a better outcome compared with the whole control group. There is a negative side to any screening programme but mortality reduction in this and other trials suggests that a national programme of colorectal cancer screening should be given consideration.


Keywords: screening; colorectal cancer; faecal occult blood test; Haemoccult; colonoscopy

Full Text

The Full Text of this article is available as a PDF (77.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahlquist D. A. Fecal occult blood testing for colorectal cancer. Can we afford to do this? Gastroenterol Clin North Am. 1997 Mar;26(1):41–55. doi: 10.1016/s0889-8553(05)70282-x. [DOI] [PubMed] [Google Scholar]
  2. Hara A. K., Johnson C. D., Reed J. E., Ahlquist D. A., Nelson H., Ehman R. L., McCollough C. H., Ilstrup D. M. Detection of colorectal polyps by computed tomographic colography: feasibility of a novel technique. Gastroenterology. 1996 Jan;110(1):284–290. doi: 10.1053/gast.1996.v110.pm8536869. [DOI] [PubMed] [Google Scholar]
  3. Hardcastle J. D., Chamberlain J. O., Robinson M. H., Moss S. M., Amar S. S., Balfour T. W., James P. D., Mangham C. M. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996 Nov 30;348(9040):1472–1477. doi: 10.1016/S0140-6736(96)03386-7. [DOI] [PubMed] [Google Scholar]
  4. Kronborg O., Fenger C., Olsen J., Jørgensen O. D., Søndergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996 Nov 30;348(9040):1467–1471. doi: 10.1016/S0140-6736(96)03430-7. [DOI] [PubMed] [Google Scholar]
  5. Lazovich D., Weiss N. S., Stevens N. G., White E., McKnight B., Wagner E. H. A case-control study to evaluate efficacy of screening for faecal occult blood. J Med Screen. 1995;2(2):84–89. doi: 10.1177/096914139500200206. [DOI] [PubMed] [Google Scholar]
  6. Macrae F. A., Tan K. G., Williams C. B. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut. 1983 May;24(5):376–383. doi: 10.1136/gut.24.5.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Mandel J. S., Bond J. H., Church T. R., Snover D. C., Bradley G. M., Schuman L. M., Ederer F. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993 May 13;328(19):1365–1371. doi: 10.1056/NEJM199305133281901. [DOI] [PubMed] [Google Scholar]
  8. Marteau T. M. Psychological costs of screening. BMJ. 1989 Aug 26;299(6698):527–527. doi: 10.1136/bmj.299.6698.527. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Mella J., Biffin A., Radcliffe A. G., Stamatakis J. D., Steele R. J. Population-based audit of colorectal cancer management in two UK health regions. Colorectal Cancer Working Group, Royal College of Surgeons of England Clinical Epidemiology and Audit Unit. Br J Surg. 1997 Dec;84(12):1731–1736. [PubMed] [Google Scholar]
  10. Rembold C. M. Number needed to screen: development of a statistic for disease screening. BMJ. 1998 Aug 1;317(7154):307–312. doi: 10.1136/bmj.317.7154.307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Rex D. K., Rahmani E. Y., Haseman J. H., Lemmel G. T., Kaster S., Buckley J. S. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology. 1997 Jan;112(1):17–23. doi: 10.1016/s0016-5085(97)70213-0. [DOI] [PubMed] [Google Scholar]
  12. Saito H., Soma Y., Koeda J., Wada T., Kawaguchi H., Sobue T., Aisawa T., Yoshida Y. Reduction in risk of mortality from colorectal cancer by fecal occult blood screening with immunochemical hemagglutination test. A case-control study. Int J Cancer. 1995 May 16;61(4):465–469. doi: 10.1002/ijc.2910610406. [DOI] [PubMed] [Google Scholar]
  13. Stower M. J., Hardcastle J. D. The results of 1115 patients with colorectal cancer treated over an 8-year period in a single hospital. Eur J Surg Oncol. 1985 Jun;11(2):119–123. [PubMed] [Google Scholar]
  14. Towler B., Irwig L., Glasziou P., Kewenter J., Weller D., Silagy C. A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, hemoccult. BMJ. 1998 Aug 29;317(7158):559–565. doi: 10.1136/bmj.317.7158.559. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Turnbull R. B., Jr, Kyle K., Watson F. R., Spratt J. Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg. 1967 Sep;166(3):420–427. doi: 10.1097/00000658-196709000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Umpleby H. C., Bristol J. B., Rainey J. B., Williamson R. C. Survival of 727 patients with single carcinomas of the large bowel. Dis Colon Rectum. 1984 Dec;27(12):803–810. doi: 10.1007/BF02553944. [DOI] [PubMed] [Google Scholar]
  17. Wahrendorf J., Robra B. P., Wiebelt H., Oberhausen R., Weiland M., Dhom G. Effectiveness of colorectal cancer screening: results from a population-based case-control evaluation in Saarland, Germany. Eur J Cancer Prev. 1993 May;2(3):221–227. [PubMed] [Google Scholar]
  18. Whynes D. K., Neilson A. R., Walker A. R., Hardcastle J. D. Faecal occult blood screening for colorectal cancer: is it cost-effective? Health Econ. 1998 Feb;7(1):21–29. doi: 10.1002/(sici)1099-1050(199802)7:1<21::aid-hec306>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  19. Whynes D. K., Walker A. R., Chamberlain J. O., Hardcastle J. D. Screening and the costs of treating colorectal cancer. Br J Cancer. 1993 Nov;68(5):965–968. doi: 10.1038/bjc.1993.462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Zappa M., Castiglione G., Grazzini G., Falini P., Giorgi D., Paci E., Ciatto S. Effect of faecal occult blood testing on colorectal mortality: results of a population-based case-control study in the district of Florence, Italy. Int J Cancer. 1997 Oct 9;73(2):208–210. doi: 10.1002/(sici)1097-0215(19971009)73:2<208::aid-ijc8>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES