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Intervention in large bowel carcinogenesis--does screening improve prognosis?

P A Farrands, D C Britton

    Scandinavian Journal of Gastroenterology. Supplement
    |January 1, 1984
    PubMed
    Summary

    Screening for colorectal cancer using faecal occult blood tests showed poor patient compliance and low sensitivity. This Haemoccult slide test demonstrated a 30% false-positive rate and a 20% false-negative rate, making it inefficient for early detection.

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    Area of Science:

    • Gastroenterology
    • Oncology
    • Public Health

    Background:

    • Colorectal cancer is a leading cause of cancer death in the Western world, with stagnant survival rates over the past 30 years.
    • Early detection of colorectal cancer significantly improves patient prognosis, with 5-year survival rates of approximately 90% for localized disease versus 30% for tumors with lymphatic spread.
    • Identifying methods for detecting early-stage colorectal tumors is crucial for improving patient outcomes.

    Purpose of the Study:

    • To evaluate the effectiveness of faecal occult blood screening using Haemoccult slides for detecting early-stage colorectal cancer in an asymptomatic population.
    • To assess the compliance rates, sensitivity, and specificity of the Haemoccult test in a real-world screening setting.

    Main Methods:

    • A screening program invited 8,925 asymptomatic individuals over 40 to undergo faecal occult blood testing using Haemoccult slides.

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  • A total of 2,439 individuals (27% compliance rate) participated in the screening.
  • Positive results were further investigated to determine false-positive rates, and cancer diagnoses were confirmed through subsequent medical evaluation.

    • Main Results:

    • The screening achieved a low compliance rate of 27%.
    • The Haemoccult test exhibited a 30% false-positive rate (39 out of 121 initial positives).
    • Twelve bowel tumors (8 polyps, 4 cancers) were identified, but the test also yielded a 20% false-negative rate, with one cancer diagnosed shortly after a negative screen.

    Conclusions:

    • The study highlights significant challenges in implementing faecal occult blood screening for colorectal cancer.
    • Low population compliance and the disappointing sensitivity (high false-negative rate) of the Haemoccult test render this screening method practically inefficient despite its theoretical potential.
    • Improvements in screening test sensitivity and patient engagement strategies are necessary for effective early detection of colorectal cancer.