Colorectal cancer screening with faecal testing, sigmoidoscopy or colonoscopy: a systematic review and network meta-analysis

Abstract

ObjectiveEvaluate effectiveness, harms and burdens of faecal blood testing, sigmoidoscopy and colonoscopy screening for colorectal cancer over 15 years.DesignWe performed an update of a Cochrane systematic review, and performed network meta-analysis comparing randomised trials evaluating colorectal cancer screening with guaiac faecal occult blood test (gFOBT) (annual, biennial), faecal immunochemical test (FIT) (annual, biennial), sigmoidoscopy (once-only) or colonoscopy (once-only) in a healthy population, aged 50–79 years. We conducted subgroup analysis on sex. Follow-up >5 years was required for analysis of colorectal cancer incidence and mortality.Results12 randomised trials proved eligible. Compared with no-screening, we found high certainty evidence for sigmoidoscopy screening slightly reducing colorectal cancer incidence (relative risk (RR) 0.76; 95% confidence interval (CI 0.70 to 0.83) and mortality (RR 0.74; 95% CI 0.69 to 0.80), while gFOBT screening had little or no difference on colorectal cancer incidence, but slightly reduced colorectal cancer mortality (annual: RR 0.69; 95% CI 0.56 to 0.86, biennial: RR 0.88; 95% CI 0.82 to 0.93). No screening test reduced mortality nor incidence by more than six per 1000 screened over 15 years. Sigmoidoscopy had a greater effect in men, for both colorectal cancer incidence (women: RR 0.86; 95% CI 0.81 to 0.92, men: RR 0.75, 95% CI 0.71 to 0.79), and mortality (women: RR 0.85; 95% CI 0.71 to 0.96, men: RR 0.67; 95% CI 0.61 to 0.75) (moderate certainty).ConclusionsIn a 15-year perspective, sigmoidoscopy reduces colorectal cancer incidence, while sigmoidoscopy, annual and biennial gFOBT all reduce colorectal cancer mortality. Sigmoidoscopy may reduce colorectal cancer incidence and mortality more in men than in women.PROSPERO registration numberCRD42018093401.

Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study

“…Our study has several limitations. First, MISCAN-Colon could not replicate the sex-specific differences in colorectal cancer incidence and mortality reduction as observed in the NORCCAP sigmoidoscopy screening trials16 (appendix 3 (table 1)), despite the sex-specific adjustments to the model 5. On the one hand, it may be that the dwell time of adenomas differs between men and women, potentially because the proportion of cancers in the proximal colon is higher in women.…”

“…The QCancer (10 year) calculator performed better than other prediction tools when externally validated against the UK Biobank cohort. However, like the other colorectal cancer risk prediction tools, it is far from perfect and, with an area under the curve of 0.67 in men and 0.65 in women, it poorly discriminates between those at a lower and those at a higher risk, which may lead to misclassification of individual baseline colorectal cancer risk 1653…”

“…Jodal HC, Helsingen LM, Anderson JC, et al Colorectal cancer screening with faecal testing, sigmoidoscopy or colonoscopy: a systematic review and network meta-analysis. BMJ Open 2019;0:e032773 16…”

Identification of Potential Tumor-educated Platelets RNA Biomarkers for Pan Cancer Detection and Staging

“…In 2020, 1806,590 new cancer cases were reported with a death toll of 606,520 [1]. Cancer early detection is critical to prevent cancer from reaching an incurable state, and may improve cancer survival [2,3]. Although the rapid development of medical technology, the diagnosis of cancer is still limited by some conditions [4,5].…”

Cancer Screening: No Longer the Default

“…In the case of colorectal cancer, the new recommendations were driven by evidence that screening reduces cancer mortality by a modest 6 per 1000 over 15 years, with no impact on overall mortality. 2 Moreover, screening is associated with rare but real harms-including bleeding requiring hospitalization and colonic perforation. For these reasons, the new guidelines suggest that colon cancer screening should be reserved for those with an estimated 15-year colon cancer risk above 3%-a population that might have more to gain.…”