The impact of population-based faecal occult blood test screening on colorectal cancer mortality: a matched cohort study

Br J Cancer. 2012 Jul 10;107(2):255-9. doi: 10.1038/bjc.2012.277. Epub 2012 Jun 26.


Background: Randomised trials show reduced colorectal cancer (CRC) mortality with faecal occult blood testing (FOBT). This outcome is now examined in a routine, population-based, screening programme.

Methods: Three biennial rounds of the UK CRC screening pilot were completed in Scotland (2000-2007) before the roll out of a national programme. All residents (50-69 years) in the three pilot Health Boards were invited for screening. They received a FOBT test by post to complete at home and return for analysis. Positive tests were followed up with colonoscopy. Controls, selected from non-pilot Health Boards, were matched by age, gender, and deprivation and assigned the invitation date of matched invitee. Follow-up was from invitation date to 31 December 2009 or date of death if earlier.

Results: There were 379 655 people in each group (median age 55.6 years, 51.6% male). Participation was 60.6%. There were 961 (0.25%) CRC deaths in invitees, 1056 (0.28%) in controls, rate ratio (RR) 0.90 (95% confidence interval (CI) 0.83-0.99) overall and 0.73 (95% CI 0.65-0.82) for participants. Non-participants had increased CRC mortality compared with controls, RR 1.21 (95% CI 1.06-1.38).

Conclusion: There was a 10% relative reduction in CRC mortality in a routine screening programme, rising to 27% in participants.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Colonoscopy / methods
  • Colorectal Neoplasms / blood*
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / mortality*
  • Colorectal Neoplasms / prevention & control
  • Confidence Intervals
  • Feces / chemistry*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Occult Blood
  • Pilot Projects
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Scotland / epidemiology
  • Social Class