Mass screening for colorectal cancer by testing for occult blood under restricted diet and a questionnaire in Osaka

Because of the recent increase in the incidence of colorectal cancer in Japan, attempts were made to find an effective method for screening asymptomatic patients with this cancer. A total of 12,520 participants in Osaka were screened in a 2-year program from April 1982 by a test of fecal occult blood under a restricted diet, and a medical questionnaire. Occult blood in feces was examined for 3 consecutive days using one guaiac-impregnated slide (Shionogi B) each day. This slide was about twice as sensitive as the Hemoccult slide. Further diagnostic workups were required in 3,452 individuals, of which 2,602 (75.7%) were due to positive occult blood. Proctosigmoidoscopy was performed in 2,214 (64.4%) of these persons, barium enema in 1,397 persons, and flexible colonoscopy in 187 persons. Colorectal cancers were detected in 18 patients (0.14% of the total screened); ten of these cancers were in an early stage. Thus this screening method is reliable for detecting asymptomatic cancer of the colon and rectum.