Professor Stephen Halloran


Honorary Professor

Research

Publications

J Wardle, C von Wagner, I Kralj-Hans, SP Halloran, SG Smith, LM McGregor, G Vart, R Howe, J Snowball, G Handley, RF Logan, S Rainbow, S Smith, MC Thomas, N Counsell, S Morris, SW Duffy, A Hackshaw, S Moss, W Atkin, R Raine (2016)Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials, In: LANCET387(10020)pp. 751-759 ELSEVIER SCIENCE INC
S Halloran, J Snowball, J Slyfield (2009)How good is the guaiac-based faecal occult blood test for population screening of colorectal cancer?, In: Clinical Chemistry55(6 (Sup)pp. A117-?
J Watson, K Shaw, M MacGregor, S Smith, S Halloran, J Patnick, V Beral, J Green (2013)Use of research questionnaires in the NHS Bowel Cancer Screening Programme in England: impact on screening uptake, In: JOURNAL OF MEDICAL SCREENING20(4)pp. 192-197 ROYAL SOC MEDICINE PRESS LTD
AJE GREEN, SP HALLORAN, CJG SUTTON, BJ STARKEY, G MCKEE, BTB MANNERS, AW WALKER (1988)DIAGNOSTIC-SIGNIFICANCE OF OCTADECA-9,11-DIENOIC ACID IN CERVICAL NEOPLASIA, In: LANCET2(8606)pp. 309-311 LANCET LTD
LM McGregor, C von Wagner, W Atkin, I Kralj-Hans, SP Halloran, G Handley, RF Logan, S Rainbow, S Smith, J Snowball, MC Thomas, SG Smith, G Vart, R Howe, N Counsell, A Hackshaw, S Morris, SW Duffy, R Raine, J Wardle (2016)Reducing the Social Gradient in Uptake of the NHS Colorectal Cancer Screening Programme Using a Narrative-Based Information Leaflet: A Cluster-Randomised Trial, In: GASTROENTEROLOGY RESEARCH AND PRACTICEARTN 36701 HINDAWI PUBLISHING CORP
SP Halloran, J Snowball, J Slyfield (2009)How Good is the Guaiac-based Faecal Occult Blood Test for Population Screening?, In: CLINICAL CHEMISTRY55(6)pp. A117-A118
C Burtonwood, P Butler, M Young, S Halloran (2012)MONITORING FAECAL OCCULT BLOOD TEST POSITIVITY IN THE NHS BOWEL CANCER SCREENING PROGRAMME, In: GUT61pp. A334-A334 B M J PUBLISHING GROUP
R Raine, SW Duffy, J Wardle, F Solmi, S Morris, R Howe, I Kralj-Hans, J Snowball, N Counsell, S Moss, A Hackshaw, C von Wagner, G Vart, L McGregor, SG Smith, S Halloran, G Handley, RF Logan, S Rainbow, S Smith, MC Thomas, W Atkin (2016)Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening, In: BRITISH JOURNAL OF CANCER114(3)pp. 321-326 NATURE PUBLISHING GROUP
Stephen P. Halloran (2021)Colorectal cancer screening and the COVID-19 pandemic - Lessons learnt, In: Preventive medicine151106539pp. 106539-106539 Elsevier Inc

•COVID-19 pandemic interrupted most national CRC screening programs•Clinical impact of interrupted screening services is substantial•Most programs provided screening services during 2nd & 3rd waves•Learnt lessons, forward planning, redesigned robust systems will minimise future impact

Evelien Dekker, Han-Mo Chiu, Iris Lansdorp-Vogelaar, Steve Halloran (2020)Colorectal Cancer Screening in the Novel Coronavirus Disease-2019 Era, In: Gastroenterology (New York, N.Y. 1943)159(6)1998pp. 1998-2003
Robert S. Bresalier, Carlo Senore, Graeme P. Young, James Allison, Robert Benamouzig, Sally Benton, Patrick M. M. Bossuyt, Luis Caro, Beatriz Carvalho, Han-Mo Chiu, Veerle M. H. Coupe, Willemijn de Klaver, Clasine Maria de Klerk, Evelien Dekker, Sunil Dolwani, Callum G. Fraser, William Grady, Lydia Guittet, Samir Gupta, Stephen P. Halloran, Ulrike Haug, Geir Hoff, Steven Itzkowitz, Tim Kortlever, Anastasios Koulaouzidis, Uri Ladabaum, Beatrice Lauby-Secretan, Marcis Leja, Bernard Levin, Theodore Robert Levin, Finlay Macrae, Gerrit A. Meijer, Joshua Melson, Colm O'Morain, Susan Parry, Linda Rabeneck, David F. Ransohoff, Roque Saenz, Hiroshi Saito, Silvia Sanduleanu-Dascalescu, Robert E. Schoen, Kevin Selby, Harminder Singh, Robert J. C. Steele, Joseph J. Y. Sung, Erin Leigh Symonds, Sidney J. Winawer, Steve Halloran (2023)An efficient strategy for evaluating new non-invasive screening tests for colorectal cancer: The guiding principles, In: Gut72(10)pp. 1904-1918 Bmj Publishing Group

ObjectiveNew screening tests for colorectal cancer (CRC) are rapidly emerging. Conducting trials with mortality reduction as the end point supporting their adoption is challenging. We re-examined the principles underlying evaluation of new non-invasive tests in view of technological developments and identification of new biomarkers. DesignA formal consensus approach involving a multidisciplinary expert panel revised eight previously established principles. ResultsTwelve newly stated principles emerged. Effectiveness of a new test can be evaluated by comparison with a proven comparator non-invasive test. The faecal immunochemical test is now considered the appropriate comparator, while colonoscopy remains the diagnostic standard. For a new test to be able to meet differing screening goals and regulatory requirements, flexibility to adjust its positivity threshold is desirable. A rigorous and efficient four-phased approach is proposed, commencing with small studies assessing the test's ability to discriminate between CRC and non-cancer states (phase I), followed by prospective estimation of accuracy across the continuum of neoplastic lesions in neoplasia-enriched populations (phase II). If these show promise, a provisional test positivity threshold is set before evaluation in typical screening populations. Phase III prospective studies determine single round intention-to-screen programme outcomes and confirm the test positivity threshold. Phase IV studies involve evaluation over repeated screening rounds with monitoring for missed lesions. Phases III and IV findings will provide the real-world data required to model test impact on CRC mortality and incidence. ConclusionNew non-invasive tests can be efficiently evaluated by a rigorous phased comparative approach, generating data from unbiased populations that inform predictions of their health impact.

Amanda J. Cross, Jonathan Myles, Paul Greliak, Allan Hackshaw, Stephen Halloran, Sally C. Benton, Caroline Addison, Caroline Chapman, Natasha Djedovic, Stephen Smith, Christian von Wagner, Stephen W. Duffy, Rosalind Raine, Steve Halloran (2021)Including a general practice endorsement letter with the testing kit in the Bowel Cancer Screening Programme: Results of a cluster randomised trial, In: Journal of medical screening28(4)0969141321997480pp. 419-425 Sage

Objectives To evaluate the effect of general practitioner endorsement accompanying the screening kit rather than with the invitation letter on participation in the NHS Bowel Cancer Screening Programme and on the socioeconomic gradient in participation in the Programme. Methods The NHS Bowel Cancer Screening Programme in England is delivered via five regional hubs. In early 2016, we carried out a cluster-randomised trial, with hub-day of invitation as the randomisation unit. We randomised 150 hub-days of invitation to the intervention group, GP endorsement on the letter accompanying the guaiac faecal occult blood testing kit (75 hub-days, 197,366 individuals) or control, usual letter (75 hub-days, 197,476 individuals). The endpoint was participation, defined as return of a valid kit within 18 weeks of initial invitation. Because of the cluster randomisation, data were analysed by a hierarchical logistic regression, allowing a random effect for date of invitation. Socioeconomic status was represented by the index of multiple deprivation. Results Participation was 59.4% in the intervention group and 58.7% in the control group, a significant difference (p = 0.04). There was no heterogeneity of the effect of intervention by index of multiple deprivation. We found that there was some confounding between date and screening episode order (first or subsequent screen). This in turn may have induced confounding with age and slightly diluted the result. Conclusions General practitioner endorsement induces a modest increase in participation in bowel cancer screening, but does not affect the socioeconomic gradient. When considering cluster randomisation as a research method, careful scrutiny of potential confounding is indicated in advance if possible and in analysis otherwise.

C von Wagner, G Baio, R Raine, J Snowball, S Morris, W Atkin, A Obichere, G Handley, R Logan, S Rainbow, S Smith, S Halloran, J Wardle (2011)DISPARITIES IN UPTAKE OF AN ORGANIZED NATIONAL COLORECTAL CANCER SCREENING PROGRAM: RESULTS FROM THE FIRST 2.6 MILLION INVITATIONS IN ENGLAND, In: ANN BEHAV MED41pp. S6-S6 SPRINGER
A Phalguni, H Seaman, K Routh, S Halloran, S Simpson (2015)Tests detecting biomarkers for screening of colorectal cancer: What is on the horizon?, In: GMS Health Technol Assess11pp. Doc01-?

AIM: To identify new and emerging screening tests for colorectal cancer (CRC) that involves detection of various biomarkers like blood, DNA and RNA in samples of faeces, tissue or blood. Current practice: Screening for CRC can be done by bowel visualisation techniques and tests that measure biomarkers. The Bowel Cancer Screening Programme (BCSP) in England uses a guaiac faecal occult blood test. METHODS: The strategy was to search available literature, identify developers and contact them for relevant information. Advice from experts was sought on potential utility and likely impact of identified technologies on the BCSP. RESULTS: Ninety-three companies and five research groups were contacted. Sixty-nine relevant tests were identified. Detailed information was available for 48 tests, of these 73% were CE marked and the remainder were considered as emerging. Forty-nine tests use immunochemical methods to detect occult blood in faeces. Eight, four and two tests detect biomarkers in a sample of blood, or exfoliated cells either shed in faeces or collected from rectal mucosa respectively. Six tests were grouped as 'other tests'. Most of the identified tests are performed manually and give qualitative detection of biomarkers. CONCLUSION: Variation in test performance and characteristics was observed amongst the 69 identified tests. Automated, quantitative FIT with a variable cut off are the preferred approach in the BSCP. However the units used to report FITs results do not enable comparison across products. Tests detecting biomarkers other than occult blood are more specific to neoplasms but have limited sensitivity due to the heterogeneity of cancer. Research is ongoing to identify an optimal panel of biomarkers, simplifying and automating the test, and reducing the cost.

SC Benton, HE Seaman, SP Halloran (2015)Faecal occult blood testing for colorectal cancer screening: the past or the future., In: Curr Gastroenterol Rep17(2)pp. 428-?

Screening for colorectal cancer (CRC) reduces CRC mortality; many countries have implemented population-based CRC screening programmes and many more are poised to do so. Whilst several different CRC screening modalities are available, choice will be influenced by cost, available resources (e.g. high-quality colonoscopy) and acceptability of the test by the invited population. For CRC screening, no screening test has so far surpassed the practicality, affordability and effectiveness of tests for the presence of blood in faeces (faecal occult blood tests, FOBt). The results of several large FOBt-based randomised controlled trials provide the best clinical evidence to support their use in population-based CRC screening. This review considers the current options for CRC screening and the future for FOBt.

SP Halloran (2009)Bowel cancer screening, In: Surgery27(9)pp. 397-400
GP Young, EL Symonds, JE Allison, SR Cole, CG Fraser, SP Halloran, EJ Kuipers, HE Seaman (2015)Advances in Fecal Occult Blood Tests: The FIT Revolution, In: DIGESTIVE DISEASES AND SCIENCES60(3)pp. 609-622 SPRINGER
H Seaman, M Young, S Halloran (2012)THE NHS BOWEL CANCER SCREENING PROGRAMME, SOUTHERN HUB-SCREENING ACTIVITY AND OUTCOMES, In: GUT61pp. A335-A335 B M J PUBLISHING GROUP
SH Lo, G Vart, J Snowball, SP Halloran, J Wardle, C von Wagner (2012)The impact of media coverage of the Flexible Sigmoidoscopy Trial on English colorectal screening uptake, In: JOURNAL OF MEDICAL SCREENING19(2)pp. 83-88 ROYAL SOC MEDICINE PRESS LTD
P Hewitson, AM Ward, C Heneghan, SP Halloran, D Mant (2011)Primary care endorsement letter and a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial, In: BRITISH JOURNAL OF CANCER105(4)pp. 475-480 NATURE PUBLISHING GROUP
JA Cooper, SM Moss, S Smith, HE Seaman, S Taylor-Phillips, N Parsons, SP Halloran (2016)FIT for the future: a case for risk-based colorectal cancer screening using the faecal immunochemical test, In: COLORECTAL DISEASE18(7)pp. 650-653 WILEY-BLACKWELL
E MacRae, A Brenner, J Martin, S Pearson, C Piggott, H Bowyer, G Vart, C von Wagner, J Wardle, S Halloran, W Atkin (2014)SENSITIVITY OF ANNUAL FAECAL IMMUNOCHEMICAL TESTS FOR HAEMOGLOBIN (FIT) FOR DETECTING ADVANCED NEOPLASIA IN PATIENTS UNDERGOING THREE-YEARLY SURVEILLANCE COLONOSCOPY - THE FIT FOR FOLLOW-UP STUDY, In: GUT63pp. A20-A21 BMJ PUBLISHING GROUP
L von Karsa, J Patnick, N Segnan, W Atkin, S Halloran, I Lansdorp-Vogelaar, N Malila, S Minozzi, S Moss, P Quirke, RJ Steele, M Vieth, L Aabakken, L Altenhofen, R Ancelle-Park, N Antoljak, A Anttila, P Armaroli, S Arrossi, J Austoker, R Banzi, C Bellisario, J Blom, H Brenner, M Bretthauer, MC Cancela, G Costamagna, J Cuzick, M Dai, J Daniel, E Dekker, N Delicata, S Ducarroz, H Erfkamp, JA Espinas, J Faivre, LF Wood, A Flugelman, S Frkovic-Grazio, B Geller, L Giordano, G Grazzini, J Green, C Hamashima, C Herrmann, P Hewitson, G Hoff, I Holten, R Jover, MF Kaminski, EJ Kuipers, J Kurtinaitis, R Lambert, G Launoy, W Lee, R Leicester, M Leja, D Lieberman, T Lignini, E Lucas, E Lynge, S Madai, J Marinho, JM Zakotnik, G Minoli, C Monk, A Morais, R Muwonge, M Nadel, L Neamtiu, MP Tuser, M Pignone, C Pox, M Primic-Zakelj, J Psaila, L Rabeneck, D Ransohoff, M Rasmussen, J Regula, J Ren, G Rennert, J Rey, RH Riddell, M Risio, V Rodrigues, H Saito, C Sauvaget, A Scharpantgen, W Schmiegel, C Senore, M Siddiqi, D Sighoko, R Smith, S Smith, S Suchanek, E Suonio, W Tong, S Tornberg, E Van Cutsem, L Vignatelli, P Villain, L Voti, H Watanabe, J Watson, S Winawer, G Young, V Zaksas, M Zappa, R Valori (2013)European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication, In: ENDOSCOPY45(1)pp. 51-59 GEORG THIEME VERLAG KG
CG Fraser, SP Halloran, JE Allison, GP Young (2013)Making colorectal cancer screening FITTER for purpose with quantitative faecal immunochemical tests for haemoglobin (FIT), In: CLINICAL CHEMISTRY AND LABORATORY MEDICINE51(11)pp. 2065-2067 WALTER DE GRUYTER GMBH
W. Atkin, A.J. Cross, I. Kralj-Hans, E. Macrae, C. Piggott, S. Pearson, K. Wooldrage, J. Brown, F. Lucas, A. Prendergast, N. Marchevsky, B. Patel, K. Pack, R. Howe, H. Skrobanski, N. Swart, J. Snowball, S.W. Duffy, S. Morris, C. von Wagner, S. Halloran, Robert Stephen Kerrison (2019)Faecal immunochemical tests versus colonoscopy for post-poly pectomy surveillance: An accuracy, acceptability and economic study, In: HEALTH TECHNOLOGY ASSESSMENT23(1)pp. I-84 NIHR JOURNALS LIBRARY

Background In the UK, patients with one or two adenomas, of which at least one is ≥ 10 mm in size, or three or four small adenomas, are deemed to be at intermediate risk of colorectal cancer (CRC) and referred for surveillance colonoscopy 3 years post polypectomy. However, colonoscopy is costly, can cause discomfort and carries a small risk of complications. Objectives To determine whether or not annual faecal immunochemical tests (FITs) are effective, acceptable and cost saving compared with colonoscopy surveillance for detecting CRC and advanced adenomas (AAs). Design Diagnostic accuracy study with health psychology assessment and economic evaluation. Setting Participants were recruited from 30 January 2012 to 30 December 2013 within the Bowel Cancer Screening Programme in England. Participants Men and women, aged 60–72 years, deemed to be at intermediate risk of CRC following adenoma removal after a positive guaiac faecal occult blood test were invited to participate. Invitees who consented and returned an analysable FIT were included. Intervention We offered participants quantitative FITs at 1, 2 and 3 years post polypectomy. Participants testing positive with any FIT were referred for colonoscopy and not offered further FITs. Participants testing negative were offered colonoscopy at 3 years post polypectomy. Acceptibility of FIT was assessed using discussion groups, questionnaires and interviews. Main outcome measures The primary outcome was 3-year sensitivity of an annual FIT versus colonoscopy at 3 years for detecting advanced colorectal neoplasia (ACN) (CRC and/or AA). Secondary outcomes included participants’ surveillance preferences, and the incremental costs and cost-effectiveness of FIT versus colonoscopy surveillance. Results Of 8008 invitees, 5946 (74.3%) consented and returned a round 1 FIT. FIT uptake in rounds 2 and 3 was 97.2% and 96.9%, respectively. With a threshold of 40 µg of haemoglobin (Hb)/g faeces (hereafter referred to as µg/g), positivity was 5.8% in round 1, declining to 4.1% in round 3. Over three rounds, 69.2% (18/26) of participants with CRC, 34.3% (152/443) with AAs and 35.6% (165/463) with ACN tested positive at 40 µg/g. Sensitivity for CRC and AAs increased, whereas specificity decreased, with lower thresholds and multiple rounds. At 40 µg/g, sensitivity and specificity of the first FIT for CRC were 30.8% and 93.9%, respectively. The programme sensitivity and specificity of three rounds at 10 µg/g were 84.6% and 70.8%, respectively. Participants’ preferred surveillance strategy was 3-yearly colonoscopy plus annual FITs (57.9%), followed by annual FITs with colonoscopy in positive cases (31.5%). FIT with colonoscopy in positive cases was cheaper than 3-yearly colonoscopy (£2,633,382), varying from £485,236 (40 µg/g) to £956,602 (10 µg/g). Over 3 years, FIT surveillance could miss 291 AAs and eight CRCs using a threshold of 40 µg/g, or 189 AAs and four CRCs using a threshold of 10 µg/g. Conclusions Annual low-threshold FIT with colonoscopy in positive cases achieved high sensitivity for CRC and would be cost saving compared with 3-yearly colonoscopy. However, at higher thresholds, this strategy could miss 15–30% of CRCs and 40–70% of AAs. Most participants preferred annual FITs plus 3-yearly colonoscopy. Further research is needed to define a clear role for FITs in surveillance. Future work Evaluate the impact of ACN missed by FITs on quality-adjusted life-years.

CG Fraser, JE Allison, SP Halloran, GP Young, on behalf of the Expert Working Group on Fecal Immunochemical Te (2012)A Proposal to Standardize Reporting Units for Fecal Immunochemical Tests for Hemoglobin., In: J Natl Cancer Inst

Fecal immunochemical tests for hemoglobin are replacing traditional guaiac fecal occult blood tests in population screening programs for many reasons. However, the many available fecal immunochemical test devices use a range of sampling methods, differ with regard to hemoglobin stability, and report hemoglobin concentrations in different ways. The methods for sampling, the mass of feces collected, and the volume and characteristics of the buffer used in the sampling device also vary among fecal immunochemical tests, making comparisons of test performance characteristics difficult. Fecal immunochemical test results may be expressed as the hemoglobin concentration in the sampling device buffer and, sometimes, albeit rarely, as the hemoglobin concentration per mass of feces. The current lack of consistency in units for reporting hemoglobin concentration is particularly problematic because apparently similar hemoglobin concentrations obtained with different devices can lead to very different clinical interpretations. Consistent adoption of an internationally accepted method for reporting results would facilitate comparisons of outcomes from these tests. We propose a simple strategy for reporting fecal hemoglobin concentration that will facilitate the comparison of results between fecal immunochemical test devices and across clinical studies. Such reporting is readily achieved by defining the mass of feces sampled and the volume of sample buffer (with confidence intervals) and expressing results as micrograms of hemoglobin per gram of feces. We propose that manufacturers of fecal immunochemical tests provide this information and that the authors of research articles, guidelines, and policy articles, as well as pathology services and regulatory bodies, adopt this metric when reporting fecal immunochemical test results.

SH Lo, S Halloran, J Snowball, H Seaman, J Wardle, C von Wagner (2015)Predictors of repeat participation in the NHS bowel cancer screening programme, In: BRITISH JOURNAL OF CANCER112(1)pp. 199-206 NATURE PUBLISHING GROUP
KE Nnoaham, A Frater, P Roderick, G Moon, S Halloran (2010)Do geodemographic typologies explain variations in uptake in colorectal cancer screening? An assessment using routine screening data in the south of England, In: JOURNAL OF PUBLIC HEALTH32(4)pp. 572-581 OXFORD UNIV PRESS
R Steele, I Forgacs, G McCreanor, S Benton, M Machesney, C Rees, SP Halloran, M Abulafi, D Alsina (2015)SUSPECTED CANCER IN ADULTS Use of faecal occult blood tests in symptomatic patients, In: BMJ-BRITISH MEDICAL JOURNAL351ARTN h4256 BMJ PUBLISHING GROUP
B Kearns, S Whyte, HE Seaman, J Snowball, SP Halloran, P Butler, J Patnick, C Nickerson, J Chilcott (2016)Factors associated with completion of bowel cancer screening and the potential effects of simplifying the screening test algorithm, In: BRITISH JOURNAL OF CANCER114(3)pp. 327-333 NATURE PUBLISHING GROUP
S Whyte, J Chilcott, S Halloran (2012)Re-appraisal of the options for colorectal cancer screening in England., In: Colorectal Dis

Aims:  To use newly available data to estimate the cost-effectiveness and endoscopy requirements of screening options for colorectal cancer(CRC) to inform screening policy in England. Methods:  A state transition model simulated the life experience of a cohort of individuals in the general population of England with normal colon/rectal epithelium through to the development of adenomas and CRC and subsequent death. CRC natural history model parameters and screening test characteristics were estimated simultaneously by a process of model calibration. This process fitted to observed data on CRC incidence in the absence of screening, data from existing screening programmes, and data from the UK flexible sigmoidoscopy(FS) screening trial. The costs, effects and resource impact were evaluated for a range of screening options involving the guaiac or immunochemical faecal occult blood test(gFOBT/iFOBT) and FS. Results:  The model suggests that screening strategies involving FS or iFOBT may produce additional benefits when compared with the current policy of biennial gFOBT for 60-74 year olds. The age at which a single FS screen results in the greatest Quality Adjusted Life Years(QALY) gain was 55, with similar gains for ages between 52 and 58. Strategies which combined FS and iFOBT showed further benefits and improved economic outcomes. Conclusions:  Strategies which combine different screening modalities may provide greater clinical and economic benefits. The collection of comprehensive screening data using a uniform format will enable comparative analysis across screening programmes in different countries, will improve our understanding of the disease, and will allow identification of optimal screening modalities. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

Fecal immunochemical tests for hemoglobin (FIT) are changing the manner in which colorectal cancer (CRC) is screened. Although these tests are being performed worldwide, why is this test different from its predecessors? What evidence supports its adoption? How can this evidence best be used? This review addresses these questions and provides an understanding of FIT theory and practices to expedite international efforts to implement the use of FIT in CRC screening.

CG Fraser, JE Allison, GP Young, SP Halloran (2013)Quantitation of hemoglobin improves fecal immunochemical tests for noninvasive screening, In: Clinical Gastroenterology and Hepatology11(7)pp. 839-840
C von Wagner, G Baio, R Raine, J Snowball, S Morris, W Atkin, A Obichere, G Handley, RF Logan, S Rainbow, S Smith, S Halloran, J Wardle (2011)Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England, In: INTERNATIONAL JOURNAL OF EPIDEMIOLOGY40(3)pp. 712-718 OXFORD UNIV PRESS
G Grazzini, M Zappa, L Ventura, T Rubeca, SP Halloran (2011)Different seasons with decreased performance of immunochemical faecal occult blood tests in colorectal cancer screening Response, In: GUT60(9)pp. 1304-1304 B M J PUBLISHING GROUP
SP Halloran (2014)SCREENING Colorectal cancer screening-insights and challenges, In: NATURE REVIEWS GASTROENTEROLOGY & HEPATOLOGY11(10)pp. 586-587 NATURE PUBLISHING GROUP
G Grazzini, L Ventura, M Zappa, S Ciatto, M Confortini, S Rapi, T Rubeca, CB Visioli, SP Halloran (2010)Influence of seasonal variations in ambient temperatures on performance of immunochemical faecal occult blood test for colorectal cancer screening: observational study from the Florence district, In: GUT59(11)pp. 1511-1515 B M J PUBLISHING GROUP
HL Bowyer, G Vart, I Kralj-Hans, W Atkin, SP Halloran, H Seaman, J Wardle, C von Wagner (2013)Patient attitudes towards faecal immunochemical testing for haemoglobin as an alternative to colonoscopic surveillance of groups at increased risk of colorectal cancer, In: JOURNAL OF MEDICAL SCREENING20(3)pp. 149-156 ROYAL SOC MEDICINE PRESS LTD
JE Allison, CG Fraser, SP Halloran, GP Young (2012)Comparing Fecal Immunochemical Tests: Improved Standardization Is Needed, In: GASTROENTEROLOGY142(3)pp. 422-424 W B SAUNDERS CO-ELSEVIER INC
NJ Massat, SM Moss, SP Halloran, SW Duffy (2013)Screening and Primary prevention of Colorectal Cancer: a Review of sex-specific and site-specific differences, In: JOURNAL OF MEDICAL SCREENING20(3)pp. 125-148 ROYAL SOC MEDICINE PRESS LTD

Multidisciplinary, evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the International Agency for Research on Cancer. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The chapter on faecal occult blood testing includes 21 graded recommendations. The content of the chapter is presented here to promote international discussion and collaboration by making the principles and standards recommended in the new EU Guidelines known to a wider professional and scientific community. Following these recommendations has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of screening programmes and services.

S Morris, G Baio, E Kendall, C von Wagner, J Wardle, W Atkin, SP Halloran, G Handley, RF Logan, A Obichere, S Rainbow, S Smith, J Snowball, R Raine (2012)Socioeconomic variation in uptake of colonoscopy following a positive faecal occult blood test result: a retrospective analysis of the NHS Bowel Cancer Screening Programme, In: BRITISH JOURNAL OF CANCER107(5)pp. 765-771 NATURE PUBLISHING GROUP
CG Fraser, JE Allison, GP Young, SP Halloran (2012)Newer Fecal Tests: Opportunities for Professionals in Laboratory Medicine, In: CLINICAL CHEMISTRY58(6)pp. 963-965 AMER ASSOC CLINICAL CHEMISTRY
GP Young, C Senore, JS Mandel, JE Allison, WS Atkin, R Benamouzig, PMM Bossuyt, MD Silva, L Guittet, SP Halloran, U Haug, G Hoff, SH Itzkowitz, M Leja, B Levin, GA Meijer, CA O'Morain, S Parry, L Rabeneck, P Rozen, H Saito, RE Schoen, HE Seaman, RJC Steele, JJY Sung, SJ Winawer (2016)Recommendations for a step-wise comparative approach to the evaluation of new screening tests for colorectal cancer, In: CANCER122(6)pp. 826-839 WILEY-BLACKWELL
G Grazzini, M Zappa, L Ventura, T Rubeca, SP Halloran (2010)Letter, In: Gut60(3)pp. 424-?
J Geraghty, P Butler, H Seaman, J Snowball, S Sarkar, R Blanks, S Halloran, K Bodger, CJ Rees (2014)Optimising faecal occult blood screening: retrospective analysis of NHS Bowel Cancer Screening data to improve the screening algorithm, In: BRITISH JOURNAL OF CANCER111(11)pp. 2156-2162 NATURE PUBLISHING GROUP
E French-Mowat, C Piggott, SP Halloran (2005)Analyser monitoring programme: A new venture, In: CLINICA CHIMICA ACTA355pp. S369-S369
AD Hingorani, S OHanlon, SP Halloran, JP Wright, TH Foley (1997)Evaluation of a paired creatine kinase test for the diagnosis of acute myocardial infarction in patients with a non-diagnostic electrocardiogram, In: JOURNAL OF ACCIDENT & EMERGENCY MEDICINE14(3)pp. 134-138 BRITISH MED JOURNAL PUBL GROUP
NJA WEST, SP HALLORAN, A DEBATS (1981)WHO DOES WHAT IN THE PATHOLOGY LABORATORY, In: BRITISH MEDICAL JOURNAL283(6294)pp. 793-793 BRITISH MED JOURNAL PUBL GROUP
SP HALLORAN, V MARKS, A BEHN, J WRIGHT (1986)GLUCOSE STICK MISUSE, In: LANCET2(8508)pp. 695-696 LANCET LTD
S Kralj-Hans, J Martin, S Pearson, C Piggott, H Bowyer, G Vart, C von Wagner, J Wardle, S Halloran, W Atkin (2013)Could faecal immunochemical tests for haemoglobin (FIT) change surveillance of people with intermediate risk adenomas?, In: Gut62(Suppl)pp. A139-?
S Sharp, D Cummins, S Halloran, M Donaldson, L Turnbull (2001)Explosions map occur if dry ice is placed in airtight transport containers, In: BRITISH MEDICAL JOURNAL322(7283)pp. 434-434 BRITISH MED JOURNAL PUBL GROUP
SP Halloran, CJ Piggott, E French-Mowat (2009)Analyser Monitoring Programme (AMP) for Automated Clinical Analysers 2008/2009, In: CLINICAL CHEMISTRY55(6)pp. A13-A14
S Halloran, W Bennitt (1999)Urine reagent strips: an MDA evaluation., In: Prof Nurse14(11)pp. 791-796

Despite being cheap to buy, the annual UK urine reagent strip bill is more than 4 Pounds million. Nurses need to be aware that each company's test strip works differently. They also need to learn about the external factors that can interfere with tests.

MJ Duffy, LGM Van Rossum, ST Van Turenhout, O Malminiemi, C Sturgeon, R Lamerz, A Nicolini, C Haglund, L Holubec, CG Fraser, SP Halloran (2011)Use of faecal markers in screening for colorectal neoplasia: A European group on tumor markers position paper, In: International Journal of Cancer128(1)pp. 3-11
SP HALLORAN (1995)CONTINUING MEDICAL-EDUCATION AND GIFT AUTHORSHIP, In: BRITISH MEDICAL JOURNAL310(6983)pp. 869-869 BRITISH MED JOURNAL PUBL GROUP
D Chantler, S Halloran, I Domke, K Hon (2000)Evaluation of acetaminophen reagent on the COBAS (R) INTEGRA 700 analyzer., In: CLINICAL CHEMISTRY46(6)pp. A23-A23 AMER ASSOC CLINICAL CHEMISTRY
SP HALLORAN (1989)INFLUENCE OF BLOOD-OXYGEN TENSION ON DIPSTICK GLUCOSE DETERMINATIONS, In: CLINICAL CHEMISTRY35(6)pp. 1268-1269 AMER ASSOC CLINICAL CHEMISTRY
SP Halloran (2004)Urine analysis - an MHRA perspective, In: JOURNAL OF PHARMACY AND PHARMACOLOGY56pp. S99-S99 PHARMACEUTICAL PRESS-ROYAL PHARMACEUTICAL SOC GREAT BRITIAN
JH Bettany, SP Halloran (2005)Audit of demand management protocol takeup, In: CLINICA CHIMICA ACTA355pp. S371-S371
CA Burtonwood, CJ Piggott, SP Halloran (2005)Evaluation of four POCT devices for the quantitation of microalbuminuria, In: CLINICA CHIMICA ACTA355pp. S392-S392
SP HALLORAN, DJ TORRENS, RB SIMONIS (1983)DISULFINE-BLUE INTERFERES WITH LABORATORY MEASUREMENTS OF PROTEIN AND IRON, In: LANCET1(8317)pp. 188-188 LANCET LTD
C Burtonwood, C Piggott, S Halloran (2005)Comparison of bayer semi-quantitative tests for microalbuminuria, In: CLINICA CHIMICA ACTA355pp. S392-S392
J McGuire, S Halloran, I Godber, J Kay, M Hallworth (2005)Lab tests online UK: How has the public reacted?, In: CLINICA CHIMICA ACTA355pp. S363-S363
SA Lamph, MJ Wheeler, SP Halloran (2005)GMEC evaluation of the TOSOH AIA (R)-1800 immunoassay analyser, In: CLINICA CHIMICA ACTA355pp. S368-S369
SC Benton, P Butler, K Reed, S Rickard, S Stanley, M Chesters, R Roope, SP Halloran (2015)INCREASING UPTAKE IN THE BOWEL CANCER SCREENING PROGRAMME WITH GP PARTICIPATION: THE PEARL PROJECT, In: GUT64pp. A373-A373
SP HALLORAN, DJ TORRENS (1983)EFFECTS OF THE DRUG DISULFINE BLUE ON ROUTINE BIOCHEMICAL INVESTIGATIONS, In: ANNALS OF CLINICAL BIOCHEMISTRY20(SEP)pp. 317-320 ROYAL SOC MEDICINE PRESS LTD
J LUNEC, SP HALLORAN, AG WHITE, TL DORMANDY (1981)FREE-RADICAL OXIDATION (PEROXIDATION) PRODUCTS IN SERUM AND SYNOVIAL-FLUID IN RHEUMATOID-ARTHRITIS, In: JOURNAL OF RHEUMATOLOGY8(2)pp. 233-245 J RHEUMATOL PUBL CO
SH Lo, A Ghanouni, C Rees, M Rutter, J Snowball, H Seaman, S Halloran, J Wardle, C von Wagner (2015)COLONOSCOPY COMFORT AND SUBSEQUENT FAECAL OCCULT BLOOD SCREENING UPTAKEIN THE ENGLISH BOWEL CANCER SCREENING PROGRAMME, In: GUT64pp. A373-A373
J Geraghty, J Snowball, P Butler, S Sarkar, R Blanks, S Halloran, M Rutter, C Rees (2013)Faecal occult blood test analysis in the United Kingdom bowel cancer screening programme., In: Gut62(Suppl)pp. A36-?