Screening for colorectal cancer: a general-practice-based study

A 2-year study was undertaken to determine the best way of setting up faecal occult blood screening for colorectal cancer in a single general practice in north Birmingham, a district with no pre-existing hospital-based screening programme for colorectal cancer. This programme was set up in close collaboration with the Departments of Surgery and Biochemistry at the local Good Hope Hospital Trust. This facilitated joint meetings between the staff of these hospital departments and the practice manager, who was responsible for organization of the study at the Hawthorns Surgery and also supervised the day-to-day running of the programme. Essentially, the study was organized and run by the practice manager and nurse.

The study was undertaken to prepare the way for other general practices in north Birmingham to screen selected populations for colorectal cancer.

A Haemoccult test kit was posted to patients together with an explanatory letter. The design of the screening programme was similar to the design of the 'screened arm' of the Medical Research Council (MRC) colorectal screening trial in Nottingham. On completion of the programme, questionnaires were posted to 100 responders and 100 non-responders to assess the level of patient acceptability for the screening study. A total of 3509 patients (1599 men and 1910 women) were invited to take part in the screening.

The response rate was 55.4%. Thirty-nine patients were referred from the screening study for further investigation. Colonoscopy identified nine adenomas in nine patients, and a further 12 patients were found to have colorectal carcinoma.

The findings from the study suggest that this method could be used as a model for other general practices introducing colorectal screening using Haemoccult.