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Annual faecal occult blood testing followed by colonoscopy for positives reduced colorectal cancer deaths by 33% over 13 years, the first proof that bowel cancer screening saves lives.
The Minnesota Colon Cancer Control Study randomised 46,551 volunteers aged 50-80 to annual guaiac faecal occult blood testing, biennial testing, or no screening. Positive tests led to colonoscopy.
After 13 years, colorectal cancer mortality was 33% lower with annual screening (5.88 vs 8.83 deaths per 1,000); the biennial arm showed a smaller, initially non-significant reduction that became significant with longer follow-up. Thirty-year follow-up (Shaukat 2013) confirmed relative reductions of 32% for annual and 22% for biennial screening.
This trial, with the Nottingham and Funen trials, made stool-based screening the backbone of population bowel cancer programmes, later upgraded to the faecal immunochemical test.
A cheap home stool test, repeated yearly or every two years and followed by colonoscopy when positive, prevents bowel cancer deaths. This is what national bowel screening programmes do today, with FIT replacing the older guaiac test.
A colonoscopy probably does reduce bowel cancer risk for the person who has it, but a programme that offers colonoscopy achieves much less if most people decline. Programmes based on stool tests with high uptake may deliver as much population benefit at lower cost and risk.
The evidence that a cheap home test posted to a whole population saves lives, and the reason England, Scotland, Wales and Northern Ireland all run bowel screening programmes; the 40 percent who never did the test are the reason uptake is still the biggest lever.
The second randomised trial to show the same effect in a different health system; together with Nottingham and Minnesota it made biennial stool testing an accepted public health intervention across Europe.
Shares Randomised controlled trial of faecal-occult-blood screening for colorectal cancer (Nottingham), NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood).
Shares NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation.
Shares Randomised controlled trial of faecal-occult-blood screening for colorectal cancer (Nottingham), NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood).
Shares Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, The hardest cancers are found late.
Shares NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, The hardest cancers are found late.
Shares NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation.
Shares NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation.
Shares Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, The hardest cancers are found late.