Fecal Occult Blood Tests for Colorectal Cancer Screening in Routine Medical Care: A Longitudinal Analysis From Germany.

Background: Well-organized programs for colorectal cancer (CRC) screening with fecal occult blood testing (FOBT) can reach over 70% of the eligible population. FOBT was opportunistic in Germany up to 2019. Until March 2025, it was offered annually to persons aged 50 to 54 and twice per year to persons aged 55 and above. Cross-sectional analyses revealed only moderate annual adherence rates, but it remained unclear whether the tests were used regularly by a small share of the population or sporadically by a large share of the population.

Methods: We used anonymized data from BARMER, a German statutory health insurance carrier, to study trends in adherence to annual FOBT screening among persons aged 50 to 54 over the years 2010-2022. The data pertained to 945 214 men and women who were born in the period 1960-1968.

Results: Despite the offer of annual screening, only 22.5% of men and 55.1% of women had at least one FOBT between the ages of 50 and 54. Only 0.1% of men and 1.8% of women used the screening annually as offered. The use of screening has declined even further in recent years. CRC was found in 1.4% of follow-up colonoscopies in both men and women.

Conclusion: The opportunistic mode of offering annual FOBT for CRC screening in Germany is highly ineffective, as most of the eligible population did not have even a single test from age 50 to age 54.