Intended for healthcare professionals


Results of the first round of a demonstration pilot of screening for colorectal cancer in the United Kingdom

BMJ 2004; 329 doi: (Published 15 July 2004) Cite this as: BMJ 2004;329:133
  1. UK Colorectal Cancer Screening Pilot Group (r.j.c.steele{at}
  1. Correspondence to: Professor R J C Steele, University Department of Surgery and Molecular Oncology, Ninewells Hospital, Dundee DD1 9SY
  • Accepted 6 May 2004


Objective To assess the feasibility of introducing into the UK's NHS a national screening programme for colorectal cancer based on faecal occult blood testing.

Design Demonstration pilot.

Setting Two English health authorities and three Scottish health boards.

Participants People aged 50-69 years.

Results 478 250 residents of the pilot areas were invited to take part in the screening programme. Uptake (the proportion in whom a final faecal occult blood test result was available) was 56.8% (n = 271 646). The overall rate of a positive test result was 1.9% and the rate for detecting cancer was 1.62 per 1000 people screened. Both these values were higher in Scotland than in England, higher in men than in women, and increased with age. The positive predictive value was 10.9% for cancer and 35.0% for adenoma. 552 cancers were detected by screening; 92 (16.6%) were polyp cancers. 48% of all screen detected cancers were Dukes's stage A, and 1% had metastasised at the time of diagnosis.

Conclusions Screening for colorectal cancer by testing for faecal occult blood is feasible within the context of the United Kingdom's NHS. Screening should lead to a reduction in deaths from colorectal cancer in the population offered screening.


  • Embedded Image Details of the pilot group are on

    This study forms part of the independent evaluation of the UK colorectal cancer screening pilot commissioned by the policy research programme at the Department of Health, England. The views expressed are those of the authors and not necessarily those of the Department of Health. We thank JH Scholefield, Queen's Medical Centre, Nottingham, for providing unpublished data from the Nottingham trial.

  • Contributors RJCS was director of the Scottish arm and lead clinician for Tayside; he will act as guarantor for the paper. R Parker was director of the English arm and lead clinician for the English site. FE Alexander and D Weller evaluated the results. FA Carey was the lead pathologist of the Scottish arm. C Fraser led the selection process of the faecal occult blood test and ensured the quality of the testing process. C Morton was project manager for the Scottish arm. NAG Mowat was the lead clinician for the pilot in Grampian. M Newbold was the lead pathologist of the English arm. JG Paterson was chairman of the steering group for the pilot. J Patnick was national coordinator of NHS screening programmes. K Robertshaw was project manager for the English arm. SCH Smith oversaw the testing process in England. J Wilson was the lead clinician for the pilot in Fife.

  • Funding Departments of Health in England and Scotland.

  • Competing interests None declared.

  • Ethical approval Ethical approval was not sought for the pilot. This was a decision made by the National Screening Committee, and endorsed by the Departments of Health, on the grounds that faecal occult blood screening for colorectal cancer is a technology of proved efficacy, and that the study was not research based but rather evaluated the feasibility of introducing a screening programme into the NHS.

  • Accepted 6 May 2004
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