Denis B et al. (2007) Short term outcomes of the first round of a pilot colorectal cancer screening programme with guaiac based faecal occult blood test. Gut 56: 1579–1584

Although European controlled trials of screening with a nonrehydrated guaiac-based fecal occult blood test (gFOBT) have shown it reduces colorectal cancer (CRC) deaths, real-world results could differ. Denis et al. reported the outcomes of a population-based French screening program incorporating gFOBT, which was carried out in Haut-Rhin between September 2003 and September 2006.

Residents aged 50–74 years were invited by mail to visit their general practitioner (GP) for CRC screening; those who did not respond were re-invited and then sent the test directly. Of those eligible to take the screening test, 90,706 completed a gFOBT (participation rate 55.4%). Women, people living in rural or suburban areas, and people in the 55–69 year age group had significantly higher participation rates. Patients with a positive test result were referred to their GP for colonoscopy. The gFOBT positivity rate was 3.4% and cancer detection rate was 2.3 per 1000 people screened. The positive predictive value was 42.7% for neoplasia, 23.6% for advanced adenoma, and 7.6% for cancer. The costs were calculated as €29.30 per patient screened and €13,466 per cancer detected (n = 207).

The authors attribute part of the program's success to the essential role GPs played in assessing patients' eligibility and encouraging participation. These results, together with those from the other pilot areas, have encouraged French health authorities to extend the gFOBT CRC screening program to the entire nation.