Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer.
BACKGROUND
Early detection of colorectal cancer could reduce cancer-specific mortality. The aim of this trial was to evaluate the effect of faecal occult blood test (FOBT) screening on colorectal cancer mortality in a Swedish population.


METHODS
All 68,308 citizens in Göteborg born between 1918 and 1931 were randomized to a screening or a control group at the age of 60-64 years. All were screened two to three times with rehydrated Hemoccult-II. Compliance was 70.0 per cent (23,916 individuals). Those with a positive test result were offered sigmoidoscopy and a double-contrast enema. The primary endpoint was death from colorectal cancer.


RESULTS
After a mean of 9 years from the last screening, there was a significant reduction in colorectal cancer mortality in the screening group compared with the control group. The overall risk ratio of death from colorectal cancer was 0.84 (95 per cent confidence interval 0.71 to 0.99). The groups did not differ in incidence of colorectal cancer or in overall mortality.


CONCLUSIONS
FOBT screening significantly reduces colorectal cancer mortality.
Lindholm
E
E
Department of Surgery, Institute of Surgical Sciences, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
Brevinge
H
H
Haglind
E
E
D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality*; D004733:Enema / Q000379:methods / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D012812:Sigmoidoscopy / Q000379:methods / Q000401:mortality; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology