Gastroenterology

Gastroenterology

Volume 126, Issue 7, June 2004, Pages 1674-1680
Gastroenterology

Clinical-alimentary tract
Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study1,

https://doi.org/10.1053/j.gastro.2004.02.018Get rights and content

Abstract

Background & Aims: Several randomized population-based studies have shown that screening for colorectal cancer (CRC) by fecal occult blood tests (FOBTs) can reduce CRC mortality. The aim of this French population-based study was to assess whether a similar benefit could be obtained in countries characterized by high performances in the diagnosis and management of CRC. Methods: Small-sized geographic areas, including 91,199 individuals aged 45–74 years, were allocated to either FOBT screening or no screening. Six screening rounds were performed. The FOBT was performed without diet restriction and was sent to a central analysis center and processed without rehydration. Screening group participants who had a positive test result were offered a full colonoscopy. The entire population was followed up for 11 years after study entry. Results: Acceptability of the test was 52.8% at the first screening round and varied between 53.8% and 58.3% in the successive rounds. Positivity rates were 2.1% initially and 1.4% on average in the successive rounds. CRC mortality was significantly lower in the screening population compared with the control population (mortality ratio, 0.84; 95% confidence interval, 0.71–0.99). The reduction in CRC mortality was more pronounced in those who participated at least once (mortality ratio, 0.67; 95% confidence interval, 0.56–0.81). Conclusions: Our findings, together with the results of other trials, suggest that biennial screening by FOBTs can reduce CRC mortality regardless of the quality of the health system and support attempts to introduce large-scale screening programs into the general population.

Section snippets

Patients and methods

The general design of the study has already been presented.7 Briefly, all residents from 12 administrative districts in Burgundy, France, born between 1914 and 1943 were invited to participate in a biennial screening program for CRC using a FOBT, the Hemoccult test. The screening districts were chosen to be representative of the urban/rural structure of the population. All residents from 17 administrative districts corresponding to a population of similar size were used as controls. The control

Results

Of the 45,642 subjects invited at the first screening round, 34,623 (75.8%) were offered FOBTs 6 times. Of the total number of tests offered throughout these screening rounds, 55.3% were completed. Compliance was higher in women (57.7%) than in men (52.7%), in urban areas (58.3%) than in rural areas (51.1%), and in those aged 55–64 years at the start of the study (59.3%) than in the younger (53.2%) and older (52.6%) age groups. Acceptability of the FOBT according to the screening round is shown

Discussion

In accordance with other European population-based FOBT trials, our study showed that biennial screening with FOBT results in a significant reduction in CRC mortality over an 11-year period. The 16% reduction in mortality we observed in a French well-defined population is consistent with previous results. The reduction in mortality was 18% in the Funen trial after 10 years of follow-up4 and 14% in the Nottingham trial after an average follow-up of 6.7 years.5 Cancer Registry data indicate that

Acknowledgements

The authors thank Patrick Arveux, Laurent Bedenne, Gérard Durand, Pierre Gallois, and Chantal Milan, who were involved in the study at its inception, and Brigitte Jacquier and Assia Yacine for data management.

References (18)

There are more references available in the full text version of this article.

Cited by (0)

Supported by grants from the Europe Against Cancer Programme, INSERM, the National Health System (CNAMTS, MSA, Mines), the Burgundy Regional Council, and the Ligue Nationale Contre le Cancer.

1

The following investigators participated in the study design and enrollment of participants. Practitioners: J. Addad, Y. Aguesse, M. Alfonsi, M. Ansellem, Ml. Andre Cousson, L. Badet, J.P. Bailly, J.M. Balet, M. Bally, R. Barat, D. Baron, P. Baudin, L. Baum, M.P. Bernard, C. Berthollet Ducarrouge, B. Besson, P. Billard, R. Blanc, C. Bonniel, N. Bonnin, C. Bourgeois, F. Bourgogne, B. Boutroux, M. Bouvelot, D. Brenot, M. Brochot, C. Brun, E. Bruneau, C. Buffin, J. Burlats, C. Burtin, A. Cachoux, J. Caillot, M. Carrat, D. Cerba, M. Chabert, C. Champion, A. Charvet, Jl. Chatel, E. Chevallot, J. Claerbout, M. Coissard, O. Colette, P. Colombier, P. Cousson, Jf. Cousson, G. Couturier, J. Cretin, C. Cusin, Jm. Dahluin, D. Danjou, B. Dassonville, F. Dassonville, R. Dassonville, T. Dassonville, C. Daujeard Garnier, Py. Dauvergne, S. De Gail, P. Demortiere, P. Denave, A. Dietre, L. Dijoux, S. Dijoux, Jc Druel, M. Dubersten, S. Dubost, J. Dumont, Jj. Dupont, F. Esposito, E. Faure, F. Ferriot, I. Flety Develay, Jj. Forneron, T. Fournel, B. Francais, Y. Francois, R. Frey, D. Gaimard, Jp. Gasnier, Jp. Geay, D. Gerard, D. Gereau, Mt. Gerenne, Mj. Gessin-Baldes, M. Ghislandi, I. Gonnard, P. Gonnard, Mj. Gonthier, P. Gorges, X. Gregoire, R. Gremeaux, Jf. Grosdemange, J. Guerard J, Jc. Guillemant, P. Guillemin, Jp. Guillot, F. Guillot, Jf. Guyonnard, C. Haddad, Mp. Horat, E. Hyla, Ca. Jarre, V. Joint, Jm. Joly, F. Jorry, Jp. Jurzak, Jm. Lacreuse, J. Lamour, H. Lamu, N. Landes, M. Landreau, R. Lapierre, R. Laurent, M. Lefebvre-N’guyen, B. Leger-Plumet, D. Lenormand, B. Lerendu, D. Longere, F. Lotteau, P. Maily, G. Manin, A. Mariotte, Jp. Marten, S. Martin, C. Martin, P. Mason, R. Mayot, E. Mazeron, Jp. Meyroux, P. Michot, R. Milliat, I. Morin, M. Mougenot, C. Moulle, Jc. Mourrat, P. Mura, P. Narcante, Jf. Neault, B. Neyrand, M. N’guyen Quang, V. N’guyen Tan, Jf. Noblet, G. Nourissat, L. Nouvellet, Jp. Ohnet, F. Pagand, J. Parisot, A. Pelamourges, J. Penot, F. Pernot, Jl. Peubey, P. Peyraud, C. Peyrondet, T. Phan N’gog, Jp. Picard, S. Pichelot-Fahut, A. Pierre, Jl. Pigache, M. Pigache, T. Pinette, M. Plault-Bonnet, P. Poignant, P. Ponnelle, Jj. Poquet, M. Pourprix, F. Primat, Jc. Prince, T. Prost, C. Raoux, J. Rey, S. Reyren, E. Rouffet, G. Roussel, H. Roussel, Jf. Roussot, G. Salfati, P. Saltron, L. Sauvage, P. Seneclauze, F. Sikner, I. Simonet, A. Stines, Jm. Strub, Jp. Szanto, Jp. Taupin, J. Tourny J, P. Treille, P. Trillaud, P. Vailler, J. Valette, A. Van Steenkiste, J. Vannetzel, B. Vedrine, I. Verdot, Mp. Vessot, P.Veyrat, M. Veyssere, G. Viguier, J. Villette, D. Vinci, E. Vittori, A. Voyard, Jl. Weirich, and R. Wucher. Gastroenterologists: A. Andre, Jg. Baudet, C. Bernadat, P. Bernard, B. Bouselsal, P. Derreveaux, H. Fabre, D. Fortier-Beaulieu, L. Grozel, Jp. Herr, J. Lacourt, P. Levenq, C. Naouri, A. Petigny, F. Ramond, O. Ruget, D. Saggio, E. Salles-Thomasson, A. Soupison, P. Thomas, J. Tuaillon, and A. Van Nieuwenhuyse.

View full text