An international panel has recommended against routine screening for bowel cancer among healthy older people, saying two-yearly FOBTs “may have little or no effect” on cancer incidence.

Writing in the BMJ, the 21-person panel said patients aged 50-79 must have a 3% or higher risk of bowel cancer over the next 15 years — based on personal and family medical history — for the benefits of screening to outweigh the downsides, including cost.

For these patients, about five deaths would be averted at the expense of three adverse events per 1000 people screened, they said. But most patients had a risk level of just 1-2%, meaning population screening caused more harm than good.

The panel noted the evidence for the new recommendation, which is part of the BMJ’s ‘Rapid Recommendations’ series of guidelines, was of ‘low certainty’.