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Screening for Colorectal Cancer in Adults
Systematic Evidence Reviews, No. 7
Michael P Pignone, MD, MPH, Melissa Rich, MD, Steven Teutsch, MD, MPH, Alfred Berg, MD, MPH, and Kathleen Lohr, PhD.
Author Information and Affiliations
Structured Abstract
Context:
Colorectal cancer is an important cause of cancer-related morbidity and mortality in the United States. Screening has the potential to reduce the morbidity and mortality from colorectal cancer through early detection and removal of early-stage cancers or precancerous adenomatous polyps.
Objective:
We conducted a systematic review for the US Preventive Services Task Force to assess the effectiveness and cost-effectiveness of different colorectal cancer screening tests.
Data sources:
We used recently conducted systematic reviews, the second edition of the Guide to Clinical Preventive Services, the British National Health Service Economic Evaluation database, and focused searches of MEDLINE from 1966 through September 2000 to identify relevant studies for inclusion. We also conducted hand-searches, review of bibliographies, and consultations with context experts to assure completeness.
Study selection:
When available, we included the most recent high-quality systematic review and then supplemented that review with a search for more recent articles. Full MEDLINE searches were performed to examine the accuracy of double-contrast barium enema, the rates of complications for each of the available screening tests, and for studies of the cost-effectiveness of screening. Two reviewers examined the results of each of the full searches and determined by consensus which articles should be abstracted into evidence tables.
Data extraction:
One reviewer abstracted the information from the final set of studies into evidence tables, and a second reviewer checked them for accuracy.
Data synthesis:
Direct evidence from multiple well-conducted randomized trials supports the effectiveness of fecal occult blood testing (FOBT) in decreasing colon cancer incidence and reducing mortality from colorectal cancer compared with no screening for average-risk adults over age 50. Data from well-conducted case-control studies support the effectiveness of sigmoidoscopy and possibly colonoscopy in reducing colon cancer mortality as well. A nonrandomized trial and indirect evidence support the use of combination FOBT and sigmoidoscopy. Indirect evidence from diagnostic accuracy studies suggests that double-contrast barium enema or virtual colonoscopy may also be effective compared with no screening. Data are insufficient to determine with confidence and precision the most effective or cost-effective strategies or the age at which screening should be stopped.
Conclusions:
Colorectal cancer screening is effective in reducing mortality from colorectal cancer. Current data are insufficient to determine the most effective or cost-effective strategy for screening, although all major strategies have favorable cost-effectiveness ratios compared with no screening.
Contents
- Preface
- Acknowledgments
- 1. Introduction
- 2. Methods
- 3. Results
- Digital Rectal Examination and Office Fecal Occult Blood Testing
- Fecal Occult Blood Testing
- Sigmoidoscopy
- FOBT and Sigmoidoscopy
- Double Contrast Barium Enema
- Colonoscopy
- Computed Tomography Colography
- When to Start or Stop Colorectal Cancer Screening
- Cost and Cost-effectiveness
- Screening Patients at Higher than Average Risk of Colorectal Cancer
- 4. Discussion
- References
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0011, Task Order No. 3, Technical Support of the U.S. Preventive Services Task Force. Prepared by: Research Triangle Institute/University of North Carolina Evidence-based Practice Center, Research Triangle, North Carolina.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers-patients and clinicians, health system leaders, and policymakers-make more informed decisions and improve the quality of health care services.
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
- 1
Rockville, MD 20852. www
.ahrq.gov
- Review Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force.[Ann Intern Med. 2002]Review Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force.Pignone M, Rich M, Teutsch SM, Berg AO, Lohr KN. Ann Intern Med. 2002 Jul 16; 137(2):132-41.
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- Review Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force.[Ann Intern Med. 2002]Review Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force.Pignone M, Saha S, Hoerger T, Mandelblatt J. Ann Intern Med. 2002 Jul 16; 137(2):96-104.
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- LOC101928211 [Homo sapiens]LOC101928211 [Homo sapiens]Gene ID:101928211Gene
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