© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 5, 434-437,
March 3, 1999
© 1999 Oxford University Press
ARTICLES |
Colorectal Cancer Mortality: Effectiveness of Biennial Screening for Fecal Occult Blood
Affiliations of authors: J. S. Mandel, T. R. Church, Division of Environmental and Occupational Health, School of Public Health, University of Minnesota, Minneapolis; F. Ederer, Division of Biostatistics, School of Public Health, University of Minnesota, and The EMMES Corporation, Potomac, MD; J. H. Bond, Department of Medicine, University of Minnesota, and Minneapolis Veterans Affairs Medical Center.
Correspondence to: Jack S. Mandel, Ph.D., M.P.H., Division of Environmental and Occupational Health, School of Public Health, University of Minnesota, Box 807 Mayo, 420 Delaware St., S.E., Minneapolis, MN 55455 (e-mail: jmandel{at}cccs.umn.edu).
BACKGROUND: In 1993, a randomized controlled trial in Minnesota showed, after 13 years of follow-up, that annual fecal occult blood testing was effective in reducing colorectal cancer mortality by at least 33%. Biennial screening (i.e., every 2 years) resulted in only a 6% mortality reduction. Two European trials (in England andin Denmark) subsequently showed statistically significant 15% and 18% mortality reductions with biennial screening. Herein, we provide updated results —through 18 years of follow-up— from the Minnesota trial that address the apparent inconsistent findings among the trials regarding biennial screening. METHODS: From 1976 through 1977, a total of 46 551 study subjects, aged 50-80 years, were recruited and randomly assigned to an annual screen, a biennial screen, or a control group. A screen consisted of six guaiac-impregnated fecal occult blood tests (Hemoccult®) prepared in pairs from each of three consecutive fecal samples. Participants with at least one of the six tests that were positive were invited for a diagnostic examination that included colonoscopy. All participants were followed annually to ascertain incident colorectal cancers and deaths. RESULTS: The numbers of deaths from all causes were similar among the three study groups. Cumulative 18-year colorectal cancer mortality was 33% lower in the annual group than in the control group (rate ratio, 0.67; 95% confidence interval [CI] =0.51-0.83). The biennial group had a 21% lower colorectal cancer mortality rate than the control group (rate ratio, 0.79; 95% CI =0.62-0.97). A marked reduction was also noted in the incidence of Dukes' stage D cancers in both screened groups in comparison with the control group. CONCLUSION: The results from this study, together with the other two published randomized trials of fecal occult blood screening, are consistent in demonstrating a substantial, statistically significant reduction in colorectal cancer mortality from biennial screening.
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