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

BMJ 1998; 317 doi: (Published 29 August 1998) Cite this as: BMJ 1998;317:559
  1. Towler Bernie, lecturer (bernie.towler{at},
  2. Irwig Les, professor in epidemiologyb,
  3. Glasziou Paul, reader in clinical epidemiologyc,
  4. Kewenter Jan, retired, former associate professord,
  5. Weller David, senior lecturere,
  6. Silagy Chris, professore
  1. aThe Australasian Cochrane Centre, Flinders Medical Centre, Bedford Park, Adelaide 5042, Australia
  2. bDepartment of Public Health and Community Medicine, Building A27, University of Sydney, Sydney 2006, Australia,
  3. cDepartment of Social and Preventive Medicine, University of Queensland Medical School, Herston 4006, Australia,
  4. d Department of Surgery and Pathology, Sahlgrenska Hospital, Gothenburg, Sweden,
  5. eDepartment of Evidence Based Care and General Practice, Flinders University of South Australia, Adelaide 5042, Australia
  1. Correspondence to: Dr Towler, 23 Forth St, Mackay 4740, Australia
  • Accepted 13 May 1998


Objective : To review effectiveness of screening for colorectal cancer with faecal occult blood test, Hemoccult, and to consider benefits and harms of screening.

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 respectively aged ≥ years in five countries.

Main outcome measures : Meta-analysis of effects of screening on mortality from colorectal cancer.

Results : Quality of trial design was generally high, and screening resulted in a favourable shift in the stage distribution of colorectal cancers in the screening groups. Meta-analysis of mortality results from the four randomised controlled trials showed that those allocated to screening had a reduction in mortality from colorectal cancer of 16% (relative risk 0.84 (95% confidence interval 0.77 to 0.93)). When adjusted for attendance for screening, this reduction was 23% (relative risk 0.77 (0.57 to 0.89)) for people actually screened. If a biennial Hemoccult screening programme were offered to 10 000 people and about two thirds attended for at least one Hemoccult test, 8.5 (3.6 to 13.5) deaths from colorectal cancer would be prevented over a period of 10 years.

Conclusion : Although benefits of screening are likely to outweigh harms for populations at high risk of colorectal cancer, more information is needed 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.


  • Funding None.

  • Conflict of interest None.

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