We critically analyzed the current literature on fecal occult blood testing as it pertains to colorectal cancer screening. We used articles published or referenced in the major English-language medical and gastroenterology journals for the last 10 years. Large, randomized controlled trials, case-control and cohort studies, and other sources containing information pertinent to the application of fecal occult blood testing for colorectal cancer screening were selected. Although the fecal occult blood test results are capable of predicting the presence of colorectal cancers and polyps, the sensitivity is variable in different studies and low for the latter. Nevertheless, most reports of its use emphasize that a relatively high percentage of the cancers detected are early-stage lesions. Currently available methods for colorectal cancer screening are imperfect, thereby increasing the cost-effectiveness ratio. The fecal occult blood test remains a workable approach to reducing the mortality from colorectal cancer provided it is carried out with attention to important variables such as the need for compliance, including the compliance of physicians.
(Arch Intern Med. 1995;155:2389-2402)