Short term outcomes of the first round of a pilot colorectal cancer screening programme with guaiac based faecal occult blood test.

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). METHOD: All participants were invited by mail to take part in a screening programme using a non-rehydrated gFOBT. The gFOBTs were first provided by general practitioners (GPs) and then directly mailed to individuals who failed to comply after two invitations. The setting was a French administrative district: Haut-Rhin (710,000 inhabitants). 182,981 residents aged 50-74 years were invited to participate. 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 those eligible. 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) needed to be performed for each colonoscopy detecting an advanced neoplasia was 1.8, lower in men (1.2) than in women (3.4), and decreasing 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 euro 29.3 per screened person and euro 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 cancer screening: a survey of French general practitioners]. / Dépistage du cancer colorectal. Enquête auprès des médecins généralistes d'un département français.

AIM: To determine knowledge, beliefs, self-reported practices and wishes of French general practitioners regarding colorectal cancer screening before the start of an organized screening program. METHODS: A postal survey of the 600 general practitioners of the Haut-Rhin area was made in 2002. RESULTS: Response rate was 62%. Eighty-five% asked routinely their patients about their family history of colorectal cancer. Colorectal cancer screening was routinely proposed by 92% of practitioners to individuals with a family history (86% with colonoscopy) and by 20% to individuals without family history (69% with faecal occult blood test). Seventy-five% did not know French consensus conference guidelines on colorectal cancer screening. Fifty-three% ordered routinely faecal occult blood testing, mostly for the screening of individuals with family history and for the evaluation of symptoms, mainly iron-deficiency anemia and weight loss. Seventy-seven% would explore with colonoscopy subjects with positive faecal occult blood test. Fifty-four% had personally undergone screening. Fifty-six% considered that mass screening could reduce a lot colorectal cancer mortality and most of them agreed with the forthcoming organized colorectal cancer mass screening program. CONCLUSIONS: Screening for colorectal cancer is ordered less often than screening for female cancers. General practitioners are unaware of current guidelines. Beliefs and practices vary considerably and faecal occult blood testing is often inappropriately prescribed. Medical education concerning screening is needed. Colorectal cancer screening guidelines and policy should be clarified in France.