Screening for colon cancer in Germany

Screening for colon cancer by fecal occult blood testing (Hemoccult) was started in Germany in 1977 as part of an annually offered cancer checkup. The results of the six years 1985-1990 are reviewed. Marked differences exist between male and female screenees regarding age and frequency of participation, test positivity and case finding rates. A total of some 1.500 colorectal cancers are traced annually in 4 million screenees. Test positivity and case finding rates depend in a characteristic pattern on the screening interval. A screening-out effect for colon cancer is evident in annually screened participants. Fecal occult blood testing has become part of the basic laboratory programme in the workup of patients in general medical practice. Compared to mass population screening, test positivity and case finding rates are higher, with positive predictive values 11% for cancer and 20% for large adenomatous polyps.

Fecal occult blood testing is effective for screening and case finding of colon cancer. New tests specific for human hemoglobin could further improve this simple, inexpensive and generally available screening.