BACKGROUND: Several randomized studies have shown that colorectal cancer (CRC) screening by faecal occult blood test (FOBT) reduces CRC mortality. These trials have different designs, especially concerning FOBT frequency and duration, as well as the length of follow-up after stopping FOBT campaigns. AIMS: To review the effectiveness of screening for CRC with FOBT, to consider the reduction in mortality during or after screening or to identify factors associated with a significant mortality reduction. METHODS: A systematic review of trials of FOBT screening with a meta-analysis of four controlled trials selected for their biennial and population-based design. The main outcome measurements were mortality relative risk (RR) and 95% confidence interval (CI) of biennial FOBT during short (10 years, i.e. five or six rounds) or long-term (six or more rounds) screening periods, as well as after stopping screening and follow-up during 5-7 years. The meta-analysis used the Mantel-Haenszel method with fixed effects when the heterogeneity test was not significant, and used 'intent to screen' results. RESULTS: Although the quality of the four trials was high, only three were randomized, and one used rehydrated biennial FOBT associated with a high colonoscopy rate (28%). A meta-analysis of mortality results showed that subjects allocated to screening had a reduction of CRC mortality during a 10-year period (RR 0.86; CI 0.79-0.94) although CRC mortality was not decreased during the 5-7 years after the 10-year (six rounds) screening period, nor in the last phase (8-16 years after the onset of screening) of a long-term (16 years or nine rounds) biennial screening. Whatever the design of the period of ongoing FOBT, CRC incidence neither decreased nor increased, although it was reduced for 5-7 years after the 10-year screening period. Neither the design nor the clinical or demographic parameters of these trials were independently associated with CRC mortality reduction. CONCLUSION: Biennial FOBT decreased CRC mortality by 14% when performed over 10 years, without evidence-based benefit on CRC mortality when performed over a longer period. No independent predictors of CRC mortality reduction have been identified in order to allow a CRC screening programme in any subgroups of subjects at risk.
BACKGROUND: Several randomized studies have shown that colorectal cancer (CRC) screening by faecal occult blood test (FOBT) reduces CRC mortality. These trials have different designs, especially concerning FOBT frequency and duration, as well as the length of follow-up after stopping FOBT campaigns. AIMS: To review the effectiveness of screening for CRC with FOBT, to consider the reduction in mortality during or after screening or to identify factors associated with a significant mortality reduction. METHODS: A systematic review of trials of FOBT screening with a meta-analysis of four controlled trials selected for their biennial and population-based design. The main outcome measurements were mortality relative risk (RR) and 95% confidence interval (CI) of biennial FOBT during short (10 years, i.e. five or six rounds) or long-term (six or more rounds) screening periods, as well as after stopping screening and follow-up during 5-7 years. The meta-analysis used the Mantel-Haenszel method with fixed effects when the heterogeneity test was not significant, and used 'intent to screen' results. RESULTS: Although the quality of the four trials was high, only three were randomized, and one used rehydrated biennial FOBT associated with a high colonoscopy rate (28%). A meta-analysis of mortality results showed that subjects allocated to screening had a reduction of CRC mortality during a 10-year period (RR 0.86; CI 0.79-0.94) although CRC mortality was not decreased during the 5-7 years after the 10-year (six rounds) screening period, nor in the last phase (8-16 years after the onset of screening) of a long-term (16 years or nine rounds) biennial screening. Whatever the design of the period of ongoing FOBT, CRC incidence neither decreased nor increased, although it was reduced for 5-7 years after the 10-year screening period. Neither the design nor the clinical or demographic parameters of these trials were independently associated with CRC mortality reduction. CONCLUSION: Biennial FOBT decreased CRC mortality by 14% when performed over 10 years, without evidence-based benefit on CRC mortality when performed over a longer period. No independent predictors of CRC mortality reduction have been identified in order to allow a CRC screening programme in any subgroups of subjects at risk.
Authors: David A Ahlquist; Hongzhi Zou; Michael Domanico; Douglas W Mahoney; Tracy C Yab; William R Taylor; Malinda L Butz; Stephen N Thibodeau; Linda Rabeneck; Lawrence F Paszat; Kenneth W Kinzler; Bert Vogelstein; Niels Chr Bjerregaard; Søren Laurberg; Henrik Toft Sørensen; Barry M Berger; Graham P Lidgard Journal: Gastroenterology Date: 2011-11-04 Impact factor: 22.682
Authors: A J Coldman; N Phillips; J Brisson; W Flanagan; M Wolfson; C Nadeau; N Fitzgerald; A B Miller Journal: Curr Oncol Date: 2015-04 Impact factor: 3.677
Authors: Dennis Yang; Shauna L Hillman; Ann M Harris; Pamela S Sinicrope; Mary E Devens; David A Ahlquist Journal: World J Gastroenterol Date: 2014-05-07 Impact factor: 5.742
Authors: Thomas R de Wijkerslooth; Margriet C de Haan; Esther M Stoop; Marije Deutekom; Paul Fockens; Patrick M M Bossuyt; Maarten Thomeer; Marjolein van Ballegooijen; Marie-Louise Essink-Bot; Monique E van Leerdam; Ernst J Kuipers; Evelien Dekker; Jaap Stoker Journal: BMC Gastroenterol Date: 2010-05-19 Impact factor: 3.067
Authors: Maaike J Denters; Marije Deutekom; Paul Fockens; Patrick M M Bossuyt; Evelien Dekker Journal: BMC Gastroenterol Date: 2009-04-24 Impact factor: 3.067
Authors: M H Liedenbaum; A F van Rijn; A H de Vries; H M Dekker; M Thomeer; C J van Marrewijk; L Hol; M G W Dijkgraaf; P Fockens; P M M Bossuyt; E Dekker; J Stoker Journal: Gut Date: 2009-07-21 Impact factor: 23.059