Is it reasonable to use faecal occult blood test for colorectal cancer screening?

Abstract

There is a high prevalence and incidence of colorectal cancer in industrial countries. It is the commonest cancer in women after breast cancer and in men after prostate and lung cancer and one of the most common causes of death from malignant disease. The cause of colorectal cancer is unknown, thus primary-prevention programs could not be elaborated and the only occasion to reduce mortality is the use of screening to detect this cancer early. Faecal occult blood test (FOBT) was chosen for screening. Large population based trials included thousands of inhabitants of the United States and Europe to demonstrate: 1. Screening with FOBT Hemoccult II reduced mortality from colorectal cancer. 2. In the screening group the incidence of advanced stages of colorectal cancer decreased (Dukes' D stage). 3. The ideal balance between sensitivity and specificity revealed HemeSelect (immunodiagnosis of human haemoglobine) and combined test (Hemoccult II Sensa + HemeSelect). These two screening tests for colorectal cancer have not been verified by large population trials. 4. More sensitive guaiac tests decrease their own specificity and also lead to increase rate of expensive colon examinations. 5. The high-risk population for colorectal cancer ought to be submitted to screening. The problem is the detection of this group. 6. Patients' compliance to screening differs in various trials, but the percentage of patients undergoing FOBT evaluation decreases as the number of screenings increases. Therefore faecal occult blood test could be recommended for national programs of the screening for colorectal cancer.