The risks of screening : data from the Nottingham randomised controlled trial of faecal occult blood screening for colorectal cancer.
Aims-To determine the harm that ensues from faecal occult blood (FOB) screening for colorectal cancer.
Methods-150 251 people were randomly allocated either to receive biennial Haemoccult FOB tests (n=75 253) or not to be contacted (n=74 998).
Study group patients returning positive tests were offered colonic investigation ; 1774 underwent complete investigation of the colon.
There was no significant difference in the stage at presentation of interval versus control group cancers.
Survival in the interval cancer group was significantly prolonged compared with the control group.
Sensitivity for colonoscopy or flexible sigmoidoscopy and double contrast barium enema (DCBE) was 96.7%. There were no complications of DCBE but seven (0.5%) complications of colonoscopy, of which six required surgical intervention.
There were no colonoscopy related deaths.
No patients without colorectal cancer died within 30 days of colonic investigation.
Five patients died within 30 days of surgery for screen detected colorectal neoplasia and a further two died without having surgery.
Six patients died after 30 days but within two years of surgery for screen detected benign adenomas or stage A cancers ; in all cases the cause of death was not related to colorectal cancer.
Conclusions-There was investigation related morbidity but no mortality and little to support overdiagnosis bias.
The group returning falsely negative tests had a better outcome compared with the whole control group. (...)
Mots-clés Pascal : Tumeur maligne, Côlon, Rectum, Dépistage, Intérêt, Morbidité, Etude cohorte, Randomisation, Homme, Appareil digestif pathologie, Intestin pathologie, Côlon pathologie, Rectum pathologie
Mots-clés Pascal anglais : Malignant tumor, Colon, Rectum, Medical screening, Interest, Morbidity, Cohort study, Randomization, Human, Digestive diseases, Intestinal disease, Colonic disease, Rectal disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0491316
Code Inist : 002B30A01C. Création : 22/03/2000.