![]() Nine studies (n = 6497) evaluated the test accuracy of screening computed tomography (CT) colonography, 4 of which also reported the test accuracy of colonoscopy pooled sensitivity to detect adenomas 6 mm or larger was similar between CT colonography with bowel prep (0.86) and colonoscopy (0.89). In observational studies, receipt of screening colonoscopy (2 studies, n = 436 927) or fecal immunochemical test (FIT) (1 study, n = 5.4 million) vs no screening was associated with lower risk of CRC incidence or mortality. Annual or biennial guaiac fecal occult blood test (gFOBT) vs no screening (5 trials, n = 419 966) was associated with a reduction of CRC-specific mortality after 2 to 9 rounds of screening (relative risk at 19.5 years, 0.91 relative risk at 30 years, 0.78 ). In randomized clinical trials (4 trials, n = 458 002), intention to screen with 1- or 2-time flexible sigmoidoscopy vs no screening was associated with a decrease in CRC-specific mortality (incidence rate ratio, 0.74 ). Results The review included 33 studies (n = 10 776 276) on the effectiveness of screening, 59 (n = 3 491 045) on the test performance of screening tests, and 131 (n = 26 987 366) on the harms of screening. Main Outcomes and Measures Colorectal cancer incidence and mortality, test accuracy in detecting cancers or adenomas, and serious adverse events. Random-effects meta-analyses were conducted. Study Selection English-language studies conducted in asymptomatic populations at general risk of CRC.ĭata Extraction and Synthesis Two reviewers independently appraised the articles and extracted relevant study data from fair- or good-quality studies. Objective To systematically review the effectiveness, test accuracy, and harms of screening for CRC to inform the US Preventive Services Task Force.ĭata Sources MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant studies published from January 1, 2015, to Decemsurveillance through March 26, 2021. Importance Colorectal cancer (CRC) remains a significant cause of morbidity and mortality in the US. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Key Question 2: Cologuard Sensitivity and Specificity to Detect Colorectal Cancer, Advanced Neoplasia, and Advanced Adenomas Key Question 2: Forest Plot of OC-Sensor Sensitivity and Specificity to Detect Advanced Adenomas (All Colonoscopy Follow-up), by Cutoff (μg Hb/g Feces)ĮFigure 8. Key Question 2: Forest Plot of OC-Sensor Sensitivity and Specificity to Detect Colorectal Cancer (All Colonoscopy Follow-up), by Cutoff (μg Hb/g Feces)ĮFigure 7. Key Question 2: Forest Plot of CT Colonography With Bowel Prep Sensitivity and Specificity for Adenomas ≥6 mmĮFigure 6. Key Question 2: Forest Plot of CT Colonography With Bowel Prep Sensitivity and Specificity for Adenomas ≥10 mmĮFigure 5. FS Trial Findings on CRC Incidence by SexĮFigure 4. Key Question 1: FS trial Findings on CRC Incidence and MortalityĮFigure 2. Key Question 1: Results of Screening gFOBT TrialsĮFigure 1. Study Design–Specific Quality Rating CriteriaĮTable 3. Literature Search Strategies for Primary LiteratureĮTable 2.
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