A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, Hemoccult

BMJ 1998;317:559-565 ( 29 August )

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A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, Hemoccult

Bernie Towler, lecturer, ^a Les Irwig, professor in epidemiology, ^b Paul Glasziou, reader in clinical epidemiology, ^c Jan Kewenter, retired, former associate professor, ^d David Weller, senior lecturer, ^e Chris Silagy, professor. ^e

^a The Australasian Cochrane Centre, Flinders Medical Centre, Bedford Park, Adelaide 5042, Australia, ^b Department of Public Health and Community Medicine, Building A27, University of Sydney, Sydney 2006, Australia, ^c Department of Social and Preventive Medicine, University of Queensland Medical School, Herston 4006, Australia, ^d Department of Surgery and Pathology, Sahlgrenska Hospital, Gothenburg, Sweden, ^e Department of Evidence Based Care and General Practice, Flinders University of South Australia, Adelaide 5042, Australia

Correspondence to: Dr Towler, 23 Forth St, Mackay 4740, Australia bernie.towler{at}m130.aone.net.au

Objective: To review effectiveness of screening for colorectal cancer with faecal occult blood test, Hemoccult, andto consider benefits and harms ofscreening.
Design: Systematic review of trials of Hemoccult screening, with meta-analysis of results from the randomised controlled trials.
Subjects: Four randomised controlled trials and two non-randomised trials of about 330 000 and 113 000 people respectivelyaged $>=$ 40 years in fivecountries.
Main outcome measures: Meta-analysis of effects of screening on mortality from colorectalcancer.
Results: Quality of trial design was generally high, and screening resulted in a favourable shift in the stage distributionof colorectal cancers in the screening groups. Meta-analysis ofmortality results from the four randomised controlled trials showedthat those allocated to screening had a reduction in mortalityfrom colorectal cancer of 16% (relative risk 0.84 (95% confidenceinterval 0.77 to 0.93)). When adjusted for attendance for screening,this reduction was 23% (relative risk 0.77 (0.57 to 0.89)) forpeople actually screened. If a biennial Hemoccult screening programmewere offered to 10 000 people and about two thirds attended forat least one Hemoccult test, 8.5 (3.6 to 13.5) deaths from colorectalcancer would be prevented over a period of 10years.
Conclusion: Although benefits of screening are likely to outweigh harms for populations at high risk of colorectalcancer, more information is needed about the harmful effects ofscreening, the community's responses to screening, and costs ofscreening for different healthcare systems before widespread screeningcan be recommended.

Key messages

We conducted a systematic review of trials of screening for colorectal cancer with faecal occult blood test, Hemoccult
Meta-analysis of results from the four randomised controlled trials showed that screening reduced mortality from colorectal cancer by 16% for those allocated to screening and by 23% for those who were actually screened
A biennial Hemoccult screening programme offered to 10 000 people aged $>=$ 40 years, of whom about two thirds attended for at least one test, would prevent 8.5 deaths from colorectal cancer over 10 years
Although benefits of screening are likely to outweigh harms for populations at high risk of colorectal cancer, we need more information about the harmful effects of screening, the community's responses to screening, and costs of screening for different healthcare systems before widespread screening can be recommended

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