Faecal occult blood screening for colorectal neoplasia: A randomized trial of three days or six days of tests

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Abstract
Haemoccult®, a guaiac test for faecal occult blood, detects 56–78 per cent of asymptomatic carcinomas when performed over 3 days. In patients with known colorectal cancer the sensitivity of the test for neoplasia is increased by extending the test period to 6 days. We report the first randomized comparison of 3 day with 6 day testing in asymptomatic individuals. 35184 age and sex matched individuals were randomly allocated to receive Haemoccult over 3 or 6 days. The tests were completed by 10176 (57·8 per cent) of the 17616 offered 3 day Haemoccult and 9461 (53·9 per cent) of the 17568 offered 6 day Haemoccult, a significant decrease in compliance (P<0·001). Of the 3 day Haemoccult tests 131 (1·29 per cent) were positive, significantly fewer than the 160 (1·69 per cent) positive tests after 6 day Haemoccult (0·01 < P < 0·02). Investigation of subjects with a positive test revealed 20 carcinomas (1·14 per 1000 offered and 1·97 per 1000 completing the test) in the 3 day group and 24 carcinomas (1·37 per 1000 offered and 2·54 per 1000 completing the test) after 6 day Haemoccult tests (0·5<P<0·7 for those offered the test and 0·3<P<0·5 for those completing it). After 3 day Haemoccult 112 adenomas in 76 persons were detected (4·31 per 1000 offered and 7·47 per 1000 completing the test). In the 6 day group 123 adenomas in 83 persons (4·72 per 1000 offered and 8·77 per 1000 completing the test) were detected (0·5 < P < 0·7 for those offered the test and 0·3 < P < 0·5 for those completing it). Large adenomas were found in 27 individuals after 3 day testing (1·53 per 1000 offered the test and 2·65 per 1000 completing it) and in 35 individuals after 6 day testing (1·99 per 1000 offered the test and 3·70 per 1000 completing it) (0·3<P<0·5 for those offered the test and 0·l<P<0·2 for those completing it). This study has not demonstrated a significant increase in the yield of neoplasia in asymptomatic subjects offered Haemoccult over 6 days. However there was a significant decrease in compliance and a higher rate of colonoscopy in those offered 6 day testing.

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