Should organised faecal occult blood test screening be established?

Clinical trials conducted in the Nottingham (UK), Funen (Denmark) and Minnesota (USA) using faecal occult blood testing (FOBT) showed evidence that population-based screening with FOBT could reduce mortality from colorectal cancer (CRC) [1–3]. At first glance, these results could be interpreted as positive signals for implementing large-scale screening programmes using FOBT. Faecal occult blood testing was proposed for screening in the 1970s, when fibre-optic endoscopic techniques were in development, and CRC incidence was rising. Since then, endoscopic technologies have constantly improved and become much more widely available. Furthermore, significant advances have been made in the knowledge of the biology and in the medical management of CRC. Therefore, one should be cautious with results from FOBT trials, and examine carefully how these trials relate to the changing epidemiology of CRC, and the advent of new screening techniques. Hereafter, we list seven arguments that should be considered before the implementation of screening programmes based on FOBT.