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Colorectal cancer screening

¹Division of Environmental and Occupational Health, School of Public Health, University of Minnesota, Mineapolis, USA.

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|January 20, 1998

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Screening for colorectal cancer using fecal occult blood testing can significantly reduce mortality. Annual screening with these tests offers the greatest benefit, while immunochemical tests may be more effective than guaiac-based tests.

Area of Science:

Oncology
Preventive Medicine
Gastroenterology

Background:

Colorectal cancer (CRC) is a global health concern with largely unknown etiology.
Secondary prevention through mass screening is recommended for average-risk individuals aged 50+.

Purpose of the Study:

To evaluate the evidence supporting fecal occult blood testing (FOBT) for colorectal cancer secondary prevention.
To compare guaiac-based FOBT with immunochemical FOBT (iFOBT) for CRC screening.

Main Methods:

Systematic review of three randomized controlled trials (RCTs) of guaiac-FOBT.
Analysis of observational studies on FOBT efficacy.
Comparison of guaiac-FOBT and iFOBT sensitivity and specificity.

Main Results:

Related Experiment Videos

RCTs involving over 250,000 participants showed significant CRC mortality reductions with annual and biennial guaiac-FOBT.
Observational studies corroborate RCT findings.
iFOBT may offer higher sensitivity and specificity compared to guaiac-FOBT.
Annual FOBT can reduce CRC mortality by at least 33%; biennial screening by 15-20%.

Conclusions:

Fecal occult blood testing is a justified secondary prevention strategy for colorectal cancer in average-risk asymptomatic individuals aged 50 and over.
Immunochemical FOBT is a compelling alternative to guaiac-based testing due to potential improvements in accuracy.
Flexible sigmoidoscopy and colonoscopy are not recommended for mass screening of average-risk populations but are indicated for high-risk individuals.