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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.
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.
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.
The first molecular stool test to reach approval, and the template for the blood tests that followed: more sensitive for cancer, much less specific, and still poor at the precancerous lesions that screening is supposed to remove.
The second randomised trial to show the same effect in a different health system; together with Nottingham and Minnesota it made biennial stool testing an accepted public health intervention across Europe.
A cheap home stool test, repeated yearly or every two years and followed by colonoscopy when positive, prevents bowel cancer deaths. This is what national bowel screening programmes do today, with FIT replacing the older guaiac test.
Shares Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, The Lancet and the tag colorectal-evidence.
Shares Multitarget stool DNA testing for colorectal-cancer screening, Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood) and the tag colorectal-evidence.
Shares Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The Lancet, The hardest cancers are found late and the tag colorectal-evidence.
Shares Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late and the tag colorectal-evidence.
Shares Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, The hardest cancers are found late and the tag colorectal-evidence.
Shares Faecal immunochemical test (FIT), Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late and the tag colorectal-evidence.
Shares Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, 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 and the tag colorectal-evidence.
Shares Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, The hardest cancers are found late, 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 and the tag colorectal-evidence.