Screening for Colorectal Cancer: A Targeted, Updated Systematic Review for the U.S. Preventive Services Task Force

Kaiser Permanente Center for Health Research, Portland, Oregon, USA.
Annals of internal medicine (Impact Factor: 17.81). 11/2008; 149(9):638-58.
Source: PubMed


In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended colorectal cancer screening for adults 50 years of age or older but concluded that evidence was insufficient to prioritize among screening tests or evaluate newer tests, such as computed tomographic (CT) colonography.
To review evidence related to knowledge gaps identified by the 2002 recommendation and to consider community performance of screening endoscopy, including harms.
MEDLINE, Cochrane Library, expert suggestions, and bibliographic reviews.
Eligible studies reported performance of colorectal cancer screening tests or health outcomes in average-risk populations and were at least of fair quality according to design-specific USPSTF criteria, as determined by 2 reviewers.
Two reviewers verified extracted data.
Four fecal immunochemical tests have superior sensitivity (range, 61% to 91%), and some have similar specificity (97% to 98%), to the Hemoccult II fecal occult blood test (Beckman Coulter, Fullerton, California). Tradeoffs between superior sensitivity and reduced specificity occur with high-sensitivity guaiac tests and fecal DNA, with other important uncertainties for fecal DNA. In settings with sufficient quality control, CT colonography is as sensitive as colonoscopy for large adenomas and colorectal cancer. Uncertainties remain for smaller polyps and frequency of colonoscopy referral. We did not find good estimates of community endoscopy accuracy; serious harms occur in 2.8 per 1000 screening colonoscopies and are 10-fold less common with flexible sigmoidoscopy.
The accuracy and harms of screening tests were reviewed after only a single application.
Fecal tests with better sensitivity and similar specificity are reasonable substitutes for traditional fecal occult blood testing, although modeling may be needed to determine all tradeoffs. Computed tomographic colonography seems as likely as colonoscopy to detect lesions 10 mm or greater but may be less sensitive for smaller adenomas. Potential radiation-related harms, the effect of extracolonic findings, and the accuracy of test performance of CT colonography in community settings remain uncertain. Emphasis on quality standards is important for implementing any operator-dependent colorectal cancer screening test.

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    • "Colorectal cancer screening recommendations vary between countries, but there is evidence for a reduction in cancer-specific mortality with colonoscopy, flexible sigmoidoscopy and the Fecal Occult Blood (FOB) test (Atkin et al., 2010; Hewitson et al., 2007; Whitlock et al., 2008). "
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    ABSTRACT: Guided by Fuzzy Trace Theory, this study examined the impact of a ‘Gist-based’ leaflet on colorectal cancer screening knowledge and intentions; and tested the interaction with participants’ numerical ability. Adults aged 45–59 years from four UK general practices were randomly assigned to receive standard information (‘The Facts’, n = 2,216) versus standard information plus ‘The Gist’ leaflet (Gist + Facts, n = 2,236). Questionnaires were returned by 964/4,452 individuals (22 %). 82 % of respondents reported having read the information, but those with poor numeracy were less likely (74 vs. 88 %, p < .001). The ‘Gist + Facts’ group were more likely to reach the criterion for adequate knowledge (95 vs. 91 %; p < .01), but this was not moderated by numeracy. Most respondents (98 %) intended to participate in screening, with no group differences and no interaction with numeracy. The improved levels of knowledge and self-reported reading suggest ‘The Gist’ leaflet may increase engagement with colorectal cancer screening, but ceiling effects reduced the likelihood that screening intentions would be affected. Electronic supplementary material The online version of this article (doi:10.1007/s10865-014-9596-z) contains supplementary material, which is available to authorized users.
    Full-text · Article · Sep 2014 · Journal of Behavioral Medicine
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    • "The work cannot be changed in any way or used commercially. rates (Levin et al., 2008; Whitlock et al., 2008). gFOBT detects only about 13–50% of cancers over one round of screening in asymptomatic patients (Lieberman and Weiss, 2001; Imperiale et al., 2004; Park et al., 2010), whereas FIT detects ∼ 79% of cancers over one round of screening (Lee et al., 2014). "
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    ABSTRACT: Background Fecal immunochemical tests (FITs) are recommended to screen average-risk adults for colorectal cancer (CRC). Little research has examined whether a two-sample FIT affects participant uptake, compared with a one-sample FIT. Examining participant uptake is important, as evidence suggests that a two-sample FIT may increase the sensitivity to detect CRC.Objective This study had two objectives: (i) to evaluate FIT completion in a population that received either a one-sample FIT kit (1-FIT) or a two-sample FIT kit (2-FIT) and (ii) to understand whether uptake varies by age, sex, or receipt of prior CRC screening.Methods We conducted a randomized controlled trial in which 3081 participants who were aged between 50 and 75 years and were at an average risk for CRC, and who had requested FITs, randomly received 1-FIT (n=1540) or 2-FIT (n=1541) kits. FIT completion was defined as the completion and return of a one-sample test by the patients in the 1-FIT group or of both sample tests by those in the 2-FIT group. Cox proportional hazard regression models were used to determine the independent effect of group type (2-FIT vs. 1-FIT) on the completion of the FIT, adjusting for age, sex, and receipt of prior CRC screening.ResultsThe 2-FIT group had lower test completion rates (hazard ratio=0.87; 95% confidence interval=0.78-0.97; P=0.01) after adjusting for age, sex, and receipt of prior CRC screening. Participant uptake did not vary by age, sex, or receipt of prior CRC screening.Conclusion This unique, rigorous randomized controlled trial found that the 2-FIT regimen decreases completion of FIT. Further research is needed to understand whether decreases in participant uptake are offset by increased gains in test sensitivity.
    Full-text · Article · Sep 2014 · European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP)
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    • "The systematic review carried out by the US Preventive Services Task Force (USPSTF),91 which included studies until 2007 and was based on two cohort studies (106,107 cases), point out that the sensitivity of Hemoccult Sensa® was higher for CRC than Hemoccult II® (64–80%), but specificity was lower (87–90%). Nonetheless, both the systematic CRC review and the USPSTF show that reference Hemoccult Sensa® data are scarce.91,92 "
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    ABSTRACT: Cancer is a worldwide problem as it will affect one in three men and one in four women during their lifetime. Colorectal cancer (CRC) is the third most frequent cancer in men, after lung and prostate cancer, and is the second most frequent cancer in women after breast cancer. It is also the third cause of death in men and women separately, and is the second most frequent cause of death by cancer if both genders are considered together. CRC represents approximately 10% of deaths by cancer. Modifiable risk factors of CRC include smoking, physical inactivity, being overweight and obesity, eating processed meat, and drinking alcohol excessively. CRC screening programs are possible only in economically developed countries. However, attention should be paid in the future to geographical areas with ageing populations and a western lifestyle.19,20 Sigmoidoscopy screening done with people aged 55-64 years has been demonstrated to reduce the incidence of CRC by 33% and mortality by CRC by 43%.
    Full-text · Article · Jul 2014 · Clinical Medicine Insights: Gastroenterology
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