Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force.

TitleScreening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force.
Publication TypeJournal Article
Year of Publication2002
AuthorsPignone M, Rich M, Teutsch SM, Berg AO, Lohr KN
JournalAnnals of internal medicine
Volume137
Issue2
Pagination132-41
Date Published2002 Jul 16
ISSN1539-3704
KeywordsAge Factors, Colonoscopy, Colorectal Neoplasms, Enema, Evidence-Based Medicine, Female, Humans, Male, Mass Screening, Middle Aged, Occult Blood, Physical Examination, Rectum, Sigmoidoscopy, Time Factors
Abstract

PURPOSE: To assess the effectiveness of different colorectal cancer screening tests for adults at average risk.

DATA SOURCES: Recent systematic reviews; Guide to Clinical Preventive Services, 2nd edition; and focused searches of MEDLINE from 1966 through September 2001. The authors also conducted hand searches, reviewed bibliographies, and consulted context experts to ensure completeness.

STUDY SELECTION: When available, the most recent high-quality systematic review was used to identify relevant articles. This review was then supplemented with a MEDLINE search for more recent articles.

DATA EXTRACTION: One reviewer abstracted information from the final set of studies into evidence tables, and a second reviewer checked the tables for accuracy. Discrepancies were resolved by consensus.

DATA SYNTHESIS: For average-risk adults older than 50 years of age, evidence from multiple well-conducted randomized trials supported the effectiveness of fecal occult blood testing in reducing colorectal cancer incidence and mortality rates compared with no screening. Data from well-conducted case-control studies supported the effectiveness of sigmoidoscopy and possibly colonoscopy in reducing colon cancer incidence and mortality rates. A nonrandomized, controlled trial examining colorectal cancer mortality rates and randomized trials examining diagnostic yield supported the use of fecal occult blood testing plus sigmoidoscopy. The effectiveness of barium enema is unclear. Data are insufficient to support a definitive determination of the most effective screening strategy.

CONCLUSIONS: Colorectal cancer screening reduces death from colorectal cancer and can decrease the incidence of disease through removal of adenomatous polyps. Several available screening options seem to be effective, but the single best screening approach cannot be determined because data are insufficient.

Alternate JournalAnn. Intern. Med.
PubMed ID12118972
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