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Portrait of Sophia Zackrisson. Photo

Sophia Zackrisson

Research group manager, Principal investigator, Professor, MD

Portrait of Sophia Zackrisson. Photo

Population-based screening for colorectal cancer with faecal occult blood test-do we really have enough evidence?

Author

  • Göran Ekelund
  • Jonas Manjer
  • Sophia Zackrisson

Summary, in English

INTRODUCTION: Population-based randomised controlled trials (RCT) have shown that invitation to biennial screening with faecal occult blood testing (FOBT) during 10 or more years reduced colorectal cancer-specific mortality. These results have stimulated plans to introduce mass screening in various countries; however, none of these trials has been able to show any reduction of total mortality, which should be expected with reduced disease-specific mortality in a RCT. METHODS: The aim of this review is to analyse, in more detail, the findings in these trials. The results of the trials have, in this review, been systematised and discussed in the context of potential bias, validity and effectiveness. RESULTS: It is found that the reduced cancer-specific mortality is modest and that the clinical significance may be discussed. The number of persons needed to be invited for multiple screening rounds to avoid one death in colorectal cancer (CRC) is high, ranging from about 600 to 1,200. A remarkable finding is that only one fourth of the carcinomas in those invited to the screening were actually detected by this intervention. The absence of reduced total mortality in all series is a serious problem and evokes questions about the validity in determination of cause of death. None of these trials showed any effect on incidence of CRC by removal of precancerous adenomas. CONCLUSIONS: It seems reasonable to conclude that the scientific evidence to support introduction of population-based screening programmes with FOBT appears not yet strong enough. In addition, harm/benefit and cost/effectiveness ratios are not well determined.

Department/s

  • Surgery
  • Radiology Diagnostics, Malmö
  • EpiHealth: Epidemiology for Health

Publishing year

2010

Language

English

Pages

1269-1275

Publication/Series

International Journal of Colorectal Disease

Volume

25

Document type

Journal article

Publisher

Springer

Topic

  • Gastroenterology and Hepatology

Status

Published

Research group

  • Surgery
  • Radiology Diagnostics, Malmö

ISBN/ISSN/Other

  • ISSN: 1432-1262