RANDOMIZED TRIAL OF THE ADDITION OF FLEXIBLE SIGMOIDOSCOPY TO FECAL OCCULT BLOOD TESTING FOR COLORECTAL NEOPLASIA POPULATION SCREENING

Background Published data suggest that screening might reduce the mort ality rate from colorectal neoplasia. Faecal occult blood (FOE) testin g suffers from poor sensitivity and significant numbers of interval ca ncers, both of which should be improved by the addition of flexible si gmoidoscopy (FOS). Methods This prospective, randomized study aimed to assess the compliance and neoplasia yield of FOE testing and FOS comp ared with that of FOE testing alone. From general practitioner registe rs, 6371 asymptomatic patients (3124 men, 3247 women; age range 50-74 years) were invited for screening by means of FOE testing (3128 patien ts) performed at home, or a combination of FOE testing and FOS (3243 p atients). Results Compliance with FOE testing alone was 50 per cent. I n the FOE testing/FOS group, 48 per cent returned the FOE test but onl y 20 per cent went on to FOS. Despite the poor compliance, the neoplas ia yield was four times greater in the FOE testing/FOS group. Conclusi on FOS increases the neoplasia yield but strategies to improve complia nce must be identified for this to become a population screening test.