Objective: To assess both feasibility and short-term outcomes of a population-based colorectal cancer screening programme using a biennial guaiac based faecal occult blood test (gFOBT).
Design: All participants were invited by mail to participate in a screening programme using a non rehydrated gFOBT. The gFOBTs were first provided by general practitioners (GPs) and then directly mailed to persons who failed to comply after two invitations.
Setting: A French administrative district: Haut-Rhin (710 000 inhabitants).
Participants: 182 981 residents aged 50-74 years were invited.
Results: 19 274 people (10.5%) were excluded from gFOBT screening and 90 706 completed a gFOBT, so that the participation rate was 55.4% of the eligible people. 76.5% of the completed gFOBTs were provided by GPs and 15.5% by direct mailing. The gFOBT positivity rate was 3.4%. The positive predictive value was 42.7% for neoplasia (women 30.8%, men 52.5%), 23.6% for advanced adenoma and 7.6% for cancer. The number of normal colonoscopic procedures (without neoplasia) to perform for each colonoscopy detecting an advanced neoplasia was 1.8, lower in men (1.2) than in women (3.4) and decreased with age. Detection rates for neoplasia and cancer were 12.8 and 2.3 per 1000 people screened. 206 adenocarcinomas were detected: 47.6% were stage I and 23.8% stage II. The direct cost was estimated at €29.3 per screened person and €13 466 per cancer detected.
Conclusions: Participation and diagnostic yield of controlled trials of gFOBT screening are reproducible in the real-world at an acceptable cost through an organised population-based programme involving GPs.
- colorectal neoplasms / prevention / control / diagnosis
- mass screening
- occult blood