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

  1. Evelyn P. Whitlock, MD, MPH;
  2. Jennifer S. Lin, MD, MCR;
  3. Elizabeth Liles, MD;
  4. Tracy L. Beil, MS; and
  5. Rongwei Fu, PhD
  1. From Kaiser Permanente Center for Health Research, Portland, Oregon.
    1. Figure 1.
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      Figure 1. Analytic framework and key questions (KQs).

      KQ1: What is the effectiveness of the following screening methods (alone or in combination) in reducing mortality from colorectal cancer? a. Flexible sigmoidoscopy, b. Colonoscopy, c. Computed tomographic (CT) colonography, d. Fecal screening tests: i. High-sensitivity guaiac fecal occult blood test (FOBTs); ii. Fecal immunochemical test; iii. Fecal DNA test. KQ2a: What are the sensitivity and specificity of 1) colonoscopy and 2) flexible sigmoidoscopy when used to screen for colorectal cancer in the community practice setting? KQ2b: What are the test performance characteristics of 1) CT colonography and 2) fecal screening tests (as listed in KQ1d) for colorectal cancer screening, as compared to an acceptable reference standard? KQ3a: What are age-specific rates of harm from colonoscopy and flexible sigmoidoscopy in the community practice setting? KQ3b: What are the adverse effects of newer tests, including 1) CT colonography and 2) fecal screening tests (as listed in KQ1d)?

    2. Figure 2.
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      Figure 2. Study selection.

      KQ= key question; SER= standardized evidence review. For list of key questions, see legend for Figure 1.

    3. Appendix Figure 1.
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      Appendix Figure 1. Proportion of total serious complications in colonoscopy studies.

      Test for heterogeneity for all studies based on logit of proportions using a random-effects model (P= 0.13).

      * 95% CIs are exact confidence intervals.

    4. Appendix Figure 2.
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      Appendix Figure 2. Proportion of total serious complications in flexible sigmoidoscopy studies.

      Test for heterogeneity for all studies based on logit of proportions using a random-effects model (P= 0.26).

      * 95% CIs are exact confidence intervals.

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    1. Ann Intern Med November 4, 2008 vol. 149 no. 9 638-658
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