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Annals of Oncology 13:57-60, 2002
© 2002 European Society for Medical Oncology

Debate

Should organised faecal occult blood test screening be established?

P. Autier,+

Centre for Research on Epidemiology and Health Information Systems (CRESIS), Luxemburg

Received 9 August 2001; accepted 10 October 2001.

Key words: colorectal cancer, faecal occult blood, screening

Introduction

Clinical trials conducted in the Nottingham (UK), Funen (Denmark) and Minnesota (USA) using faecal occult blood testing (FOBT) showed evidence that population-based screening with FOBT could reduce mortality from colorectal cancer (CRC) [1–3]. At first glance, these results could be interpreted as positive signals for implementing large-scale screening programmes using FOBT. Faecal occult blood testing was proposed for screening in the 1970s, when fibre-optic endoscopic techniques were in development, and CRC incidence was rising. Since then, endoscopic technologies have constantly improved and become much more widely available. Furthermore, significant advances have been made in the knowledge of the biology and in the medical management of CRC. Therefore, one should be cautious with results from FOBT trials, and examine carefully how these trials relate to the changing epidemiology of CRC, and the advent of new screening techniques. Hereafter, we list seven arguments that should be considered before . . . [Full Text of this Article]

1. FOBT screening has a modest impact on CRC mortality

2. Efficacy of FOBT is lower than reported by published trials because of the ‘disease awareness’ effect

3. FOBT affects CRC incidence marginally

4. Acceptablitity of FOBT

5. FOBT is less efficient than screening tests for other cancers

6. CRC mortality trends will be marginally affected by FOBT screening

7. Establishment of a FOBT screening programme may hinder the development of more efficient screening programmes for CRC

New techniques for CRC screening

Conclusion

Footnotes

References


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