A demonstration pilot trial for colorectal cancer screening in the United Kingdom: a new concept in the introduction of healthcare strategies

It is now accepted that screening for colorectal cancer by faecal occult blood (FOB) testing can reduce disease specific mortality. In the United Kingdom, the studies which have proved most influential are the two population based randomised trials carried out in Nottingham, England and in Funen, Denmark which showed a reduction in deaths from colorectal cancer of 15% and 18% respectively. 12 Randomised trials that compare disease specific mortality in populations which have or have not been oVered screening are essential to show the eYcacy of a screening strategy; only by this means can the biases which seem to improve the outcome in screen detected disease be eliminated. 3 However, the results of such trials may not reflect the eVectiveness of screening—that is, they cannot indicate whether or not a screening programme will be feasible when it is introduced as a national programme. By their nature, randomised trials are tightly controlled studies carried out by highly motivated people, 4 whereas a national service may be subject to variations in levels of enthusiasm and expertise. Furthermore, in population screening, compliance is crucial to success, and the level of compliance obtained by the eVorts of dedicated researchers may be diYcult to replicate in the country at large. For these reasons, the United Kingdom Government has decided to carry ou ta2y ear pilot trial to establish whether or not a national colorectal cancer screening programme is feasible. This article describes the process whereby this pilot trial has been established. Developing the pilot trial