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Population-based screening for colorectal cancer with faecal occult blood test-do we really have enough evidence?

Ekelund, Göran LU ; Manjer, Jonas LU and Zackrisson, Sophia LU (2010) In International Journal of Colorectal Disease 25. p.1269-1275
Abstract
INTRODUCTION: Population-based randomised controlled trials (RCT) have shown that invitation to biennial screening with faecal occult blood testing (FOBT) during 10 or more years reduced colorectal cancer-specific mortality. These results have stimulated plans to introduce mass screening in various countries; however, none of these trials has been able to show any reduction of total mortality, which should be expected with reduced disease-specific mortality in a RCT. METHODS: The aim of this review is to analyse, in more detail, the findings in these trials. The results of the trials have, in this review, been systematised and discussed in the context of potential bias, validity and effectiveness. RESULTS: It is found that the reduced... (More)
INTRODUCTION: Population-based randomised controlled trials (RCT) have shown that invitation to biennial screening with faecal occult blood testing (FOBT) during 10 or more years reduced colorectal cancer-specific mortality. These results have stimulated plans to introduce mass screening in various countries; however, none of these trials has been able to show any reduction of total mortality, which should be expected with reduced disease-specific mortality in a RCT. METHODS: The aim of this review is to analyse, in more detail, the findings in these trials. The results of the trials have, in this review, been systematised and discussed in the context of potential bias, validity and effectiveness. RESULTS: It is found that the reduced cancer-specific mortality is modest and that the clinical significance may be discussed. The number of persons needed to be invited for multiple screening rounds to avoid one death in colorectal cancer (CRC) is high, ranging from about 600 to 1,200. A remarkable finding is that only one fourth of the carcinomas in those invited to the screening were actually detected by this intervention. The absence of reduced total mortality in all series is a serious problem and evokes questions about the validity in determination of cause of death. None of these trials showed any effect on incidence of CRC by removal of precancerous adenomas. CONCLUSIONS: It seems reasonable to conclude that the scientific evidence to support introduction of population-based screening programmes with FOBT appears not yet strong enough. In addition, harm/benefit and cost/effectiveness ratios are not well determined. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
International Journal of Colorectal Disease
volume
25
pages
1269 - 1275
publisher
Springer
external identifiers
  • wos:000282324200001
  • pmid:20676659
  • scopus:78149413245
ISSN
1432-1262
DOI
10.1007/s00384-010-1027-1
language
English
LU publication?
yes
id
a821d458-863c-41b1-b440-2a4ff2d96fb8 (old id 1665720)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20676659?dopt=Abstract
date added to LUP
2010-09-14 09:54:51
date last changed
2018-05-29 10:44:29
@article{a821d458-863c-41b1-b440-2a4ff2d96fb8,
  abstract     = {INTRODUCTION: Population-based randomised controlled trials (RCT) have shown that invitation to biennial screening with faecal occult blood testing (FOBT) during 10 or more years reduced colorectal cancer-specific mortality. These results have stimulated plans to introduce mass screening in various countries; however, none of these trials has been able to show any reduction of total mortality, which should be expected with reduced disease-specific mortality in a RCT. METHODS: The aim of this review is to analyse, in more detail, the findings in these trials. The results of the trials have, in this review, been systematised and discussed in the context of potential bias, validity and effectiveness. RESULTS: It is found that the reduced cancer-specific mortality is modest and that the clinical significance may be discussed. The number of persons needed to be invited for multiple screening rounds to avoid one death in colorectal cancer (CRC) is high, ranging from about 600 to 1,200. A remarkable finding is that only one fourth of the carcinomas in those invited to the screening were actually detected by this intervention. The absence of reduced total mortality in all series is a serious problem and evokes questions about the validity in determination of cause of death. None of these trials showed any effect on incidence of CRC by removal of precancerous adenomas. CONCLUSIONS: It seems reasonable to conclude that the scientific evidence to support introduction of population-based screening programmes with FOBT appears not yet strong enough. In addition, harm/benefit and cost/effectiveness ratios are not well determined.},
  author       = {Ekelund, Göran and Manjer, Jonas and Zackrisson, Sophia},
  issn         = {1432-1262},
  language     = {eng},
  pages        = {1269--1275},
  publisher    = {Springer},
  series       = {International Journal of Colorectal Disease},
  title        = {Population-based screening for colorectal cancer with faecal occult blood test-do we really have enough evidence?},
  url          = {http://dx.doi.org/10.1007/s00384-010-1027-1},
  volume       = {25},
  year         = {2010},
}