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16 July 2002 | Volume 137 Issue 2 | Pages 132-141
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.
Author and Article Information
From University of North Carolina, Chapel Hill, and Research Triangle Institute, Research Triangle Park, North Carolina; Merck & Co., Inc., West Point, Pennsylvania; and University of Washington, Seattle, Washington.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the U.S. Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or Merck & Co., Inc.
Acknowledgments: The authors thank David Atkins, MD, MPH, Agency for Healthcare Research and Quality, and Eve Shapiro, managing editor of the U.S. Preventive Services Task Force (under contract to the Agency for Healthcare Research and Quality). They also thank the staff of the Research Triangle Institute–University of North Carolina Evidence-based Practice Center; Sonya Sutton, BSPH, Sheila White, and Loraine Monroe, Research Triangle Institute; and Carol Krasnov, University of North Carolina at Chapel Hill Cecil G. Sheps Center for Health Services Research.
Grant Support: This study was developed by the Research Triangle Institute–University of North Carolina Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0011), Rockville, Maryland.
Requests for Reprints: Reprints are available from the AHRQ Web site at http://www.preventiveservices.ahrq.gov and in print through the AHRQ Publications Clearinghouse (800-358-9295).
Current Author Addresses: Dr. Pignone: University of North Carolina at Chapel Hill, Department of Medicine and Cecil Sheps Center for Health Services Research, 5039 Old Clinic Building, CB #7110, Chapel Hill, NC 27599.
Dr. Teutsch: Merck & Co., Inc., 770 Sumneytown Pike, West Point, PA WP399-169.
Dr. Rich: University of North Carolina at Chapel Hill, 724 Burnett Womack, CB 7080, Chapel Hill, NC 27599.
Dr. Berg: University of Washington, Department of Family Medicine, C-408 Health Sciences, Box 356390, Seattle, WA 98195.
Dr. Lohr: Research Triangle Institute, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194. CLINICAL GUIDELINES
Screening for Colorectal Cancer in Adults at Average Risk: A Summary of the Evidence for the U.S. Preventive Services Task Force
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H. Eyre, R. Kahn, R. M. Robertson, and the ACS/ADA/AHA Collaborative Writing Committe, N. G. Clark, C. Doyle, T. Gansler, T. Glynn, Y. Hong, R. A. Smith, et al. Preventing Cancer, Cardiovascular Disease, and Diabetes: A Common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association CA Cancer J Clin, July 1, 2004; 54(4): 190 - 207. [Abstract] [Full Text] [PDF]
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 H. Eyre, R. Kahn, and R. M. Robertson Preventing Cancer, Cardiovascular Disease, and Diabetes: A common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association Diabetes Care, July 1, 2004; 27(7): 1812 - 1824. [Abstract] [Full Text] [PDF]
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 H. Eyre, R. Kahn, R. M. Robertson, the ACS/ADA/AHA Collaborative Writing Committee, ACS/ADA/AHA Collaborative Writing Committee Member, N. G. Clark, C. Doyle, Y. Hong, T. Gansler, T. Glynn, et al. Preventing Cancer, Cardiovascular Disease, and Diabetes: A Common Agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association Circulation, June 29, 2004; 109(25): 3244 - 3255. [Abstract] [Full Text] [PDF]
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D. F. Ransohoff Virtual Colonoscopy--What It Can Do vs What It Will Do JAMA, April 14, 2004; 291(14): 1772 - 1774. [Full Text] [PDF]
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S. T. Hawley, S. W. Vernon, B. Levin, and B. Vallejo Prevalence of Colorectal Cancer Screening in a Large Medical Organization Cancer Epidemiol. Biomarkers Prev., February 1, 2004; 13(2): 314 - 319. [Abstract] [Full Text] [PDF]
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 K. N. Lohr Rating the strength of scientific evidence: relevance for quality improvement programs Int. J. Qual. Health Care, February 1, 2004; 16(1): 9 - 18. [Abstract] [Full Text] [PDF]
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T. F. Imperiale, D. R. Wagner, C. Y. Lin, G. N. Larkin, J. D. Rogge, and D. F. Ransohoff Using Risk for Advanced Proximal Colonic Neoplasia To Tailor Endoscopic Screening for Colorectal Cancer Ann Intern Med, December 16, 2003; 139(12): 959 - 965. [Abstract] [Full Text] [PDF]
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D. A. Lieberman, S. Prindiville, D. G. Weiss, and W. Willett Risk Factors for Advanced Colonic Neoplasia and Hyperplastic Polyps in Asymptomatic Individuals JAMA, December 10, 2003; 290(22): 2959 - 2967. [Abstract] [Full Text] [PDF]
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S. A. Taylor, S. Halligan, C. O'Donnell, S. Morley, H. Mistry, B. P. Saunders, M. Vance, P. Bassett, A. Windsor, Y. Stern, et al. Cardiovascular Effects at Multi-Detector Row CT Colonography Compared with Those at Conventional Endoscopy of the Colon Radiology, December 1, 2003; 229(3): 782 - 790. [Abstract] [Full Text] [PDF]
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 S. J Winawer New colorectal cancer screening guidelines BMJ, October 6, 2003; 327(7418): E196 - 197. [Full Text] [PDF]
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S. A. Taylor, S. Halligan, B. P. Saunders, P. Bassett, M. Vance, and C. I. Bartram Acceptance by Patients of Multidetector CT Colonography Compared with Barium Enema Examinations, Flexible Sigmoidoscopy, and Colonoscopy Am. J. Roentgenol., October 1, 2003; 181(4): 913 - 921. [Abstract] [Full Text] [PDF]
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 D. B. Mark, L. J. Shaw, M. S. Lauer, P. G. O'Malley, and P. Heidenreich Task force #5--is atherosclerosis imaging cost effective? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1906 - 1917. [Full Text] [PDF]
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Colorectal Cancer Test Use Among Persons Aged >=50 Years--United States, 2001 JAMA, May 21, 2003; 289(19): 2492 - 2493. [Full Text] [PDF]
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J. M. E. Walsh and J. P. Terdiman Colorectal Cancer Screening: Clinical Applications JAMA, March 12, 2003; 289(10): 1297 - 1302. [Abstract] [Full Text] [PDF]
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D. M. Kirkpatrick Screening for Colorectal Cancer Ann Intern Med, February 18, 2003; 138(4): 356 - 356. [Full Text] [PDF]
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R. S. Rosson and H. M. Spiro Screening for Colorectal Cancer Ann Intern Med, February 18, 2003; 138(4): 356 - 357. [Full Text] [PDF]
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 OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02) Evid. Based Nurs., January 1, 2003; 6(1): e1 - 1. [Full Text] [PDF]
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