Screening for colorectal cancer with immunochemical faecal occult blood tests

Population-based studies have shown that guaiac faecal occult blood testing followed by colonoscopy in case of positivity can reduce colorectal cancer mortality. However these tests have been criticised for their fairly low sensitivity. For this reason attention has been given to alternative tests. The aim of this paper is to review the evidence for screening for colorectal cancer using qualitative immunochemical faecal occult blood tests. For the complete range of tested cut-off values, immunochemical faecal occult blood tests lead to higher diagnostic yield, improved sensitivity and greater participation. The optimal number of samples and the optimal cut-off value has to suit local resources and the acceptability of missed cancers. All economic evaluations, despite some differences between studies, add further arguments to support the opinion that the immunochemical faecal occult blood test is currently the most cost-effective screening test for average-risk populations. These economic evaluations provide strong arguments in favour of the 1-sample strategy. With decreasing the cut-off value similar performances can be achieved with one-compared to two day sampling. Too few data are currently available to accurately compare existing qualitative tests.