# Randomised controlled trial of faecal-occult-blood screening for colorectal cancer (Nottingham)

Source: https://onco.cc/key-papers/paper-hardcastle-nottingham-faecal-occult-blood-lancet-1996/  
OnCo record `paper-hardcastle-nottingham-faecal-occult-blood-lancet-1996` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The British trial, in 152,850 people around Nottingham, that showed offering a home stool test for hidden blood every two years cut deaths from bowel cancer by 15 percent. It is the trial the NHS Bowel Cancer Screening Programme was built on.

## Summary

Between February 1981 and January 1991, Hardcastle and colleagues recruited 152,850 people aged 45 to 74 living in the Nottingham area and randomly allocated them to faecal occult blood screening or to no screening; controls were not told about the study. Screening-group participants were sent a Haemoccult test kit with instructions from their family doctor, the tests were not rehydrated, and those with negative results were re-invited every two years. Screening stopped in February 1995, by which time participants had been offered between three and six tests, and everyone was followed to June 1995.

Of 893 cancers diagnosed in the screening group, 236 were detected by screening, 249 presented after a negative test or investigation and 400 presented in people who had never responded.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: colorectal-evidence
- Journal: The Lancet
- Year: 1996
- DOI: 10.1016/S0140-6736(96)03386-7
- Authors: Hardcastle JD, Chamberlain JO, Robinson MH, et al.
- Findings: 75,253 in the screening group and 74,998 controls after exclusions; median follow-up 7.8 years.; 44,838 (59.6 percent) completed at least one screen; 30,415 (40.4 percent) never completed any test.; 360 deaths from colorectal cancer in the screening group against 420 in controls: a 15 percent reduction, odds ratio 0.85 (95 percent CI 0.74 to 0.98, p=0.026).; 20 percent of screen-group cancers were stage A against 11 percent in controls.
- What it means: The evidence that a cheap home test posted to a whole population saves lives, and the reason England, Scotland, Wales and Northern Ireland all run bowel screening programmes; the 40 percent who never did the test are the reason uptake is still the biggest lever.
- Caveats: Guaiac testing, superseded by the more sensitive and more acceptable faecal immunochemical test.; The 15 percent mortality reduction is an intention-to-screen figure diluted by the 40 percent who never took part.; No effect on all-cause mortality was demonstrated, as in every screening trial of this size.

## Sources

- Lancet 1996: https://doi.org/10.1016/S0140-6736(96)03386-7
- PubMed: https://pubmed.ncbi.nlm.nih.gov/8942775/
- NHS bowel cancer screening: https://www.nhs.uk/tests-and-treatments/bowel-cancer-screening/

## Connected records

- key papers: [Minnesota trial: a yearly stool blood test cuts bowel cancer deaths by a third](https://onco.cc/key-papers/paper-minnesota-fobt-nejm-1993/), [Multitarget stool DNA testing for colorectal-cancer screening](https://onco.cc/key-papers/paper-imperiale-multitarget-stool-dna-screening-nejm-2014/), [Randomised study of screening for colorectal cancer with faecal-occult-blood test (Funen)](https://onco.cc/key-papers/paper-kronborg-funen-faecal-occult-blood-lancet-1996/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)](https://onco.cc/technologies/colorectal-screening/)
- terms: [Endoscopy (EGD, EUS, ERCP)](https://onco.cc/terms/endoscopy/), [Faecal immunochemical test (FIT)](https://onco.cc/terms/fit-test/)
- bottlenecks: [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/)
- ideas: [Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model](https://onco.cc/ideas/idea-crc-screening-uptake-and-age-extension/)

---
JSON: https://onco.cc/api/v1/entities/paper-hardcastle-nottingham-faecal-occult-blood-lancet-1996.json