Reducing Mortality from Colorectal Cancer by Screening for Fecal Occult Blood

Jack S. Mandel, John H. Bond, Timothy R. Church, Dale C. Snover, G. Mary Bradley, Leonard M. Schuman, Fred Ederer

Research output: Contribution to journalArticlepeer-review

2989 Scopus citations


Background: Although tests for occult blood in the feces are widely used to screen for colorectal cancers, there is no conclusive evidence that they reduce mortality from this cause. We evaluated a fecal occult-blood test in a randomized trial and documented its effectiveness. Methods: We randomly assigned 46,551 participants 50 to 80 years of age to screening for colorectal cancer once a year, to screening every two years, or to a control group. Participants who were screened submitted six guaiac-impregnated paper slides with two smears from each of three consecutive stools. About 83 percent of the slides were rehydrated. Participants who tested positive underwent a diagnostic evaluation that included colonoscopy. Vital status was ascertained for all participants over 13 years of follow-up. A committee determined causes of death. A single pathologist determined the stage of cancer for each tissue specimen. Differences in mortality from colorectal cancer, the primary study end point, were monitored with the sequential log-rank statistic. Results: The 13-year cumulative mortality per 1000 from colorectal cancer was 5.88 in the annually screened group (95 percent confidence interval, 4.61 to 7.15), 8.33 in the biennially screened group (95 percent confidence interval, 6.82 to 9.84), and 8.83 in the control group (95 percent confidence interval, 7.26 to 10.40). The rate in the annually screened group, but not in the biennially screened group, was significantly lower than that in the control group. Reduced mortality in the annually screened group was accompanied by improved survival in those with colorectal cancer and a shift to detection at an earlier stage of cancer. Conclusions: Annual fecal occult-blood testing with rehydration of the samples decreased the 13-year cumulative mortality from colorectal cancer by 33 percent., In 1993 there will be approximately 152,000 new cases of colorectal cancer in the United States and 57,000 deaths from this disease1. The cause of colorectal cancer is unknown, although associations have been reported with family history, diet, alcohol, and sedentary habits2. In the absence of definitive information to support primary-prevention programs, attention has focused on the use of screening to detect this cancer earlier, when intervention may reduce mortality3. Although the concept of occult-blood detection has existed since 1864, there was little interest in its application to the early detection of large-bowel cancer until 1967, when…

Original languageEnglish (US)
Pages (from-to)1365-1371
Number of pages7
JournalNew England Journal of Medicine
Issue number19
StatePublished - May 13 1993


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