You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial
Abstract 1:
Introduction : We conducted a cluster-r and omized trial aim ed at assessing the effect of the type of faecal occult blood , guaiac or immunochemical test on screening compliance . Methods : We sample d 130 general practitioners ( GPs ) who consented to participate in the trial . We r and omly allocated half of them to the guaiac ( Hemo-Fec ) and half to the immunochemical test ( OC-Hemodia ) . We sample d 2/10 of the GPs ' 50–75-year-old patients ( n=7332 ) and r and omly divided this population into half . One half was invited to be screened at the GP 's office and the other to the nearest gastroenterology ward . The principal outcome was the percentage of returned tests . Results : The immunochemical test had a compliance of 35.8 % and the guaiac of 30.4 % ( relative risk [ RR ] 1.20 ; 95 % confidence interval [ CI ] 1.02–1.44 ) . The difference was mostly due to a higher probability of returning the sample : 93.8 % and 88.6 % for immunochemical and guaiac , respectively ( RR 1.06 ; 95 % CI 1.02–1.10 ) . The guaiac test had a higher prevalence of positives ( 10.3 % versus 6.3 % , RR 0.603 ; 95 % CI 0.433–0.837 ) . There was a higher variability in the results obtained with the guaiac test compared with the immunochemical ( F[1 , 12 ] = 16.25 ; P=0.0017 ) . Conclusions : Compliance is more likely with the immunochemical than the guaiac test , independent of the provider . Guaiac tests show a higher variability of the results among centres . The successful implementation of a screening programme requires a period of st and ardization of the test reading in order to avoid unexpected work overload for colonscopy services


Title 2:
A higher detection rate for colorectal cancer and advanced adenomatous polyp for screening with immunochemical fecal occult blood test than guaiac fecal occult blood test, despite lower compliance rate. A prospective, controlled, feasibility study
Abstract 2:
Immunochemical fecal occult blood test ( FIT ) is a new colorectal cancer ( CRC ) screening method already recommended by the American screening guidelines . We aim ed to test the feasibility of FIT as compared to guaiac fecal occult blood test ( G‐FOBT ) in a large urban population of Tel Aviv . Average‐risk persons , aged 50–75 years , were offered FIT or G‐FOBT after r and omization according to the socioeconomic status of their clinics . Participants with positive tests underwent colonoscopy . Participants were followed through the Cancer Registry 2 years after the study . Hemoccult SENSA ™ and OC‐MICRO ™ ( three sample s , 70 ng/ml threshold ) were used . FIT was offered to 4,657 persons ( Group A ) and G‐FOBT to 7,880 persons ( Group B ) . Participation rate was 25.9 % and 28.8 % in Group A and B , respectively ( p < 0.001 ) . Positivity rate in Group A and B was 12.7 % and 3.9 % , respectively ( p < 0.001 ) . Cancer found in six ( 0.49 % ) and eight ( 0.35 % ) patients of Group A and B , respectively ( NS ) . Cancer registry follow‐up found missed cancer in five ( 0.22 % ) cases of Group B and none in Group A ( NS ) . The sensitivity , specificity , negative and positive predictive value for cancer in Group A and B were 100 % , 85.9 % , 100 % , 3.9 % and 61.5 % , 96.4 % , 99.8 % , 9.1 % , respectively . There was increased detection of advanced adenomatous polyp ( AAP )  by FIT , irrespective of age , gender , and socioeconomic status ( Per Protocol : odds ratio 2.69 , 95 % confidence interval 1.6–4.5 ; Intention to Screen : odds ratio 3.16 , 95 % confidence interval 1.8–5.4 ) . FIT is feasible in urban , average‐risk population , which significantly improved performance for detection of AAP and CRC , despite reduced participation


Title 3:
Colorectal cancer screening adherence is higher with fecal immunochemical tests than guaiac-based fecal occult blood tests: a randomized, controlled trial.
Abstract 3:
OBJECTIVES Determine whether colorectal cancer screening adherence is greater with fecal immunochemical tests ( FIT ) or guaiac-based fecal occult blood tests ( gFOBT ) . METHODS We used electronic health records to identify 3869 New Mexico Veterans Affairs Health Care System primary care patients due for screening in 2008 for whom fecal blood testing was appropriate . We invited r and omly selected patients by mail to participate in a study comparing FIT and gFOBT . We r and omly allocated 404 subjects to receive  FIT ( n=202 ) or gFOBT ( n=202 ) by mail . We determined the proportion of subjects completing testing within 90days of agreeing to participate in the study . We also used multivariate logistic regression to evaluate screening completion , adjusting for age , gender , race/ethnicity , clinic site , previous gFOBT testing , and co-morbidity . RESULTS Screening adherence was higher with FIT than gFOBT ( 61.4 % vs. 50.5 % , P=0.03 ) . The adjusted odds ratio for completing FIT vs. gFOBT was 1.56 , 95 % CI 1.04 , 2.32 . CONCLUSION In a clinic setting of patients who were due for colorectal cancer screening , adherence was significantly higher with FIT than gFOBT


Title 4:
Screening for colorectal cancer: random comparison of guaiac and immunochemical faecal occult blood testing at different cut-off levels
Abstract 4:
Immunochemical faecal occult blood testing ( FIT ) provides quantitative test results , which allows optimisation of the cut-off value for follow-up colonoscopy . We conducted a r and omised population -based trial to determine test characteristics of FIT ( OC-Sensor micro , Eiken , Japan ) screening at different cut-off levels and compare these with guaiac-based faecal occult blood test ( gFOBT ) screening in an average risk population . A representative sample of the Dutch population ( n=10 011 ) , aged 50–74 years , was 1 : 1 r and omised before invitation to gFOBT and FIT screening . Colonoscopy was offered to screenees with a positive gFOBT or FIT ( cut-off 50 ng haemoglobin/ml ) . When varying the cut-off level between 50 and 200 ng ml−1 , the positivity rate of FIT  ranged between 8.1 % ( 95 % CI : 7.2–9.1 % ) and 3.5 % ( 95 % CI : 2.9–4.2 % ) , the detection rate of advanced neoplasia ranged between 3.2 % ( 95 % CI : 2.6–3.9 % ) and 2.1 % ( 95 % CI : 1.6–2.6 % ) , and the specificity ranged between 95.5 % ( 95 % CI : 94.5–96.3 % ) and 98.8 % ( 95 % CI : 98.4–99.0 % ) . At a cut-off value of 75 ng ml−1 , the detection rate was two times higher than with gFOBT screening ( gFOBT : 1.2 % ; FIT : 2.5 % ; P<0.001 ) , whereas the number needed to scope ( NNscope ) to find one screenee with advanced neoplasia was similar ( 2.2 vs 1.9 ; P=0.69 ) . Immunochemical faecal occult blood testing is considerably more effective  than gFOBT screening within the range of tested cut-off values . From our experience , a cut-off value of 75 ng ml−1 provided an adequate positivity rate and an acceptable trade-off between detection rate and NNscope


Title 5:
A Randomised Trial of the Impact of New Faecal Haemoglobin Test Technologies on Population Participation in Screening for Colorectal Cancer
Abstract 5:
OBJECTIVES To investigate the effect on participation in colorectal cancer screening of testing for blood products in faeces using technologies that remove dietary restrictions ( i.e. immunochemical tests ) and simplify faecal sampling ( i.e. tests that use brush sampling ) . METHODS SETTING Urban residents ( n=1818 ) of Adelaide , Australia , aged between 50 and 69 years , r and omly selected from the electoral roll . DESIGN Three r and omised cohorts of 606 invitees were offered a screening test by mail in 2001 . The Hemoccult SENSA and FlexSure OBT cohorts were instructed to sample three stools using a spatula while the InSureTM cohort sample d two stools using a brush . The Hemoccult SENSA cohort was asked to restrict certain ( high-peroxidase ) foods and drugs . MAIN OUTCOME MEASURES Participation ( i.e. return of completed sample kits within 12 weeks ) and generalised linear modelling ( GLM ) of relationships between participation , test technologies and demographic variables . RESULTS Participation was 23.4 % , 30.5 % and 39.6 % for the Hemoccult , FlexSure and InSure cohorts , respectively ( chi(2)=37.1 , p<0.00001 ) . GLM demonstrated that participation was increased by 28 % by removal of restrictions ( p=0.01 ) and by 30 % by simplification of sampling ( p=0.001 ) ; both together increased participation by 66 % ( p<0.001 ) . The differences in participation between tests occurred in the first three weeks . Socio-economic status , gender or age did not significantly influence technology-based improvements in participation . CONCLUSIONS The brush-sampling faecal immunochemical test for haemoglobin ( InSure ) achieves the best participation rates by simplifying sampling and removing the need for restrictions of diet and drugs . Because participation in screening is vital to detection , this new technology should contribute to better detection of neoplasia at the population level


Title 6:
Participation in screening for colorectal cancer based on a faecal occult blood test is improved by endorsement by the primary care practitioner
Abstract 6:
OBJECTIVES : To investigate the influence of general practitioner ( GP ) endorsement on participation in screening for colorectal cancer based on a faecal occult blood test ( FOBT ) . SETTING : South Australian residents ( n=2400 ) , in 1999 , aged > 50 years . METHODS : R and om selection of three groups ( GP1 , GP2 , GP3 ) from two general practice s and of one group ( ER ) from the federal electoral roll ; n=600 per group . Without previous communication or publicity , subjects were posted an offer of screening by immunochemical FOBT . The GP1 and ER groups were invited without indication that their GP was involved ; GP2 received an invitation indicating support from the practice ; and GP3 received an invitation on practice letterhead and signed by a practice partner . A reminder was posted at 6 weeks . Participation was defined as return of correctly completed FOBT sample cards within 12 weeks . RESULTS : Participation rates were : GP1 192/600 ( 32.0 % ) , GP2 228/600 ( 38.0 % ) , and GP3 244/600 ( 40.7 % ) ; & khgr;2=10.2 , p=0.006 . Both GP2 and GP3 differed significantly from GP1 ( odds ratio ( OR ) 0.77 , 95 % confidence interval ( 95 % CI ) 0.60 to 0.98 and relative risk (RR)=0.69 , 95 % CI 0.54 to 0.87 respectively ) . ER ( 193/600 ( 32.2 % ) ) and GP1 were not significantly different . Age but not sex was significantly associated with participation . Overall test positivity rate was 4.6 % ; five malignancies were found in the 918 who performed FOBT . CONCLUSIONS : Association of a GP of recent contact with a screening offer in the form of a personalised letter of invitation achieves better participation than does the same letter from a central ised screening unit that does not mention the GP . Thus , GP enhanced participation is achievable without their actual involvement . Additional strategies are needed to further improve participation
Colorectal cancer screening programmes currently using guaiac faecal occult blood tests could improve participation rates by converting to faecal immunochemical tests .