Evidence for colorectal cancer screening

The incidence of colorectal cancer (CRC) has been increasing during the past decades, and the lifetime risk for CRC in industrialised countries is about 5%. CRC is a good candidate for screening, because it is a disease with high prevalence, has recognised precursors, and early treatment is benefici...

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Published in:Baillière's best practice & research. Clinical gastroenterology Vol. 24; no. 4; pp. 417 - 425
Main Author: Bretthauer, Michael
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ltd 01.08.2010
Elsevier Limited
Subjects:
Aged
Clinical Trials as Topic
Colonoscopy
Colorectal cancer
Colorectal cancer screening
Colorectal Neoplasms - diagnosis
Colorectal Neoplasms - epidemiology
Colorectal Neoplasms - mortality
Colorectal Neoplasms - prevention & control
Early Detection of Cancer - statistics & numerical data
Female
Gastroenterology and Hepatology
Humans
Male
Mass Screening - methods
Middle Aged
Occult Blood
Sigmoidoscopy
Colorectal cancer screening
ISSN:1521-6918, 1532-1916, 1532-1916
Online Access:Get full text
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Summary:The incidence of colorectal cancer (CRC) has been increasing during the past decades, and the lifetime risk for CRC in industrialised countries is about 5%. CRC is a good candidate for screening, because it is a disease with high prevalence, has recognised precursors, and early treatment is beneficial. This paper outlines the evidence for efficacy from randomised trials for the most commonly used CRC screening tests to reduce CRC incidence and mortality in the average-risk population. Four randomised trials have investigated the effect of guaiac-based fecal occult blood screening on CRC mortality, with a combined CRC mortality risk reduction of 15–17% in an intention-to-screen analysis, and 25% for those people who attended screening. Flexible sigmoidoscopy screening has been evaluated in three randomised trials. The observed reduction in CRC incidence varied between 23 and 80%, and between 27 and 67% for CRC mortality, respectively (intention-to-screen analyses) in the trials with long follow-up time. No randomised trials exist in other CRC screening tools, included colonoscopy screening. FOBT and flexible sigmoidoscopy are the two CRC screening methods which have been tested in randomised trials and shown to reduce CRC mortality. These tests can be recommended for CRC screening.
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ISSN:1521-6918
1532-1916
1532-1916
DOI:10.1016/j.bpg.2010.06.005