-
PloS One 2023Physical harm from Colorectal Cancer Screening tends to be inadequately measured and reported in clinical trials. Also, studies of ongoing Colorectal Cancer Screening... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Physical harm from Colorectal Cancer Screening tends to be inadequately measured and reported in clinical trials. Also, studies of ongoing Colorectal Cancer Screening programs have found more frequent and severe physical harm from screening procedures, e.g., bleeding and perforation, than reported in previous trials. Therefore, the objectives of the study were to systematically review the evidence on the risk of bleeding and perforation in Colorectal Cancer Screening.
DESIGN
Systematic review with descriptive statistics and random-effects meta-analyses.
METHODS
We systematically searched five databases for studies investigating physical harms related to Colorectal Cancer Screening. We assessed the internal and the external validity using the ROBINS-I tool and the GRADE approach. Harm estimates was calculated using mixed Poisson regression models in random-effect meta-analyses.
RESULTS
We included 89 studies. Reporting and measurement of harms was inadequate in most studies. In effect, the risk of bias was critical in 97.3% and serious in 98.3% of studies. All GRADE ratings were very low. Based on severe findings with not-critical risk of bias and 30 days follow-up, the risk of bleedings per 100,000 people screened were 8 [2;24] for sigmoidoscopy, 229 [129;408] for colonoscopy following fecal immunochemical test, 68 [39;118] for once-only colonoscopy, and 698 [443;1045] for colonoscopy following any screening tests. The risk of perforations was 88 [56;138] for colonoscopy following fecal immunochemical test and 53 [25;112] for once-only colonoscopy. There were no findings within the subcategory severe perforation with long-term follow-up for colonoscopy following any screening tests and sigmoidoscopy.
DISCUSSION
Harm estimates varied widely across studies, reporting and measurement of harms was mostly inadequate, and the risk of bias and GRADE ratings were very poor, collectively leading to underestimation of harm. In effect, we consider our estimates of perforation and bleeding as conservative, highlighting the need for better reporting and measurement in future studies.
TRIAL REGISTRATION
PROSPERO registration number: CRD42017058844.
Topics: Humans; Sigmoidoscopy; Early Detection of Cancer; Colorectal Neoplasms; Colonoscopy; Mass Screening; Hemorrhage; Occult Blood
PubMed: 37906565
DOI: 10.1371/journal.pone.0292797 -
Cancer Control : Journal of the Moffitt... Apr 2015Several screening tests are available to detect colorectal cancer (CRC) and reduce the incidence and mortality of CRC. The purpose of this review was to determine how... (Review)
Review
BACKGROUND
Several screening tests are available to detect colorectal cancer (CRC) and reduce the incidence and mortality of CRC. The purpose of this review was to determine how current CRC screening strategies for CRC compare with no screening and whether agreement exists with regard to the cost effectiveness of different strategies.
METHODS
Databases were searched for cost-effectiveness analyses focused on CRC screening strategies in the United States and published between May 2007 and February 2014. We analyzed the uses of fecal occult blood, fecal immunochemistry, and stool DNA tests, as well as sigmoidoscopy, colonoscopy, and virtual colonoscopy. A paired comparison of each screening strategy with no screening across each of the studies reviewed was conducted. A series of paired comparisons of the results reported in each of the studies is also included.
RESULTS
When compared with no screening, all CRC screening strategies evaluated in this review were cost effective. There was disagreement as to which screening strategy was the most cost effective. However, sigmoidoscopy combined with fecal blood testing always dominated either strategy alone. Studies comparing colonoscopy with fecal blood testing, sigmoidoscopy, or both had mixed results.
CONCLUSIONS
Compared with no screening, all CRC screening strategies are more cost effective. Study results disagree as to which screening strategy should be the preferred method.
Topics: Colonography, Computed Tomographic; Colonoscopy; Colorectal Neoplasms; Cost-Benefit Analysis; Early Detection of Cancer; Humans; Immunohistochemistry; Occult Blood; Sigmoidoscopy; United States
PubMed: 26068773
DOI: 10.1177/107327481502200219 -
The American Journal of Gastroenterology Dec 2018In "Contrasting Effectiveness and Cost-Effectiveness of Colorectal Cancer (CRC) Screening under Commercial Insurance vs. Medicare", Ladabaum et al. model different CRC...
In "Contrasting Effectiveness and Cost-Effectiveness of Colorectal Cancer (CRC) Screening under Commercial Insurance vs. Medicare", Ladabaum et al. model different CRC screening scenarios that vary the combination of payer, perspective, screening ages, and time horizons. Fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), colonoscopy and flexible sigmoidoscopy were all cost effective compared to no screening, even if initiating or stopping at age 65 years. Assuming perfect adherence, FIT and FOBT were cost saving and dominated colonoscopy. Screening between ages 50 and 64 years appeared relatively costly if only a limited time horizon was considered since the benefits accrue after age 65 years under Medicare.
Topics: Aged; Colonoscopy; Colorectal Neoplasms; Cost-Benefit Analysis; Early Detection of Cancer; Humans; Insurance Carriers; Mass Screening; Medicare; Middle Aged; Occult Blood; Sigmoidoscopy; United States
PubMed: 30374119
DOI: 10.1038/s41395-018-0386-z -
BMJ (Clinical Research Ed.) Apr 2014To review, summarise, and compare the evidence for effectiveness of screening sigmoidoscopy and screening colonoscopy in the prevention of colorectal cancer occurrence... (Comparative Study)
Comparative Study Meta-Analysis Review
Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies.
OBJECTIVES
To review, summarise, and compare the evidence for effectiveness of screening sigmoidoscopy and screening colonoscopy in the prevention of colorectal cancer occurrence and deaths.
DESIGN
Systematic review and meta-analysis of randomised controlled trials and observational studies.
DATA SOURCES
PubMed, Embase, and Web of Science. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality ratings.
ELIGIBILITY CRITERIA
Randomised controlled trials and observational studies in English on the impact of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality in the general population at average risk.
RESULTS
For screening sigmoidoscopy, four randomised controlled trials and 10 observational studies were identified that consistently found a major reduction in distal but not proximal colorectal cancer incidence and mortality. Summary estimates of reduction in distal colorectal cancer incidence and mortality were 31% (95% confidence intervals 26% to 37%) and 46% (33% to 57%) in intention to screen analysis, 42% (29% to 53%) and 61% (27% to 79%) in per protocol analysis of randomised controlled trials, and 64% (50% to 74%) and 66% (38% to 81%) in observational studies. For screening colonoscopy, evidence was restricted to six observational studies, the results of which suggest tentatively an even stronger reduction in distal colorectal cancer incidence and mortality, along with a significant reduction in mortality from cancer of the proximal colon. Indirect comparisons of results of observational studies on screening sigmoidoscopy and colonoscopy suggest a 40% to 60% lower risk of incident colorectal cancer and death from colorectal cancer after screening colonoscopy even though this incremental risk reduction was statistically significant for deaths from cancer of the proximal colon only.
CONCLUSIONS
Compelling and consistent evidence from randomised controlled trials and observational studies suggests that screening sigmoidoscopy and screening colonoscopy prevent most deaths from distal colorectal cancer. Observational studies suggest that colonoscopy compared with flexible sigmoidoscopy decreases mortality from cancer of the proximal colon. This added value should be examined in further research and weighed against the higher costs, discomfort, complication rates, capacities needed, and possible differences in compliance.
Topics: Canada; Colonic Neoplasms; Colonoscopy; Early Detection of Cancer; Europe; Humans; Incidence; Observational Studies as Topic; Randomized Controlled Trials as Topic; Rectal Neoplasms; Risk Reduction Behavior; Sigmoidoscopy; United States
PubMed: 24922745
DOI: 10.1136/bmj.g2467 -
World Journal of Gastroenterology Dec 2014To conduct a systematic review and meta-analysis of published population-based randomized controlled trials (RCTs). (Meta-Analysis)
Meta-Analysis Review
AIM
To conduct a systematic review and meta-analysis of published population-based randomized controlled trials (RCTs).
METHODS
RCTs evaluating the difference in mortality and incidence of colorectal cancer (CRC) between a screening flexible sigmoidoscopy (FS) group and control group (not assigned to screening FS) with a minimum 5 years median follow-up were identified by a search of MEDLINE and EMBASE databases and the Cochrane Central Register for Controlled Trials through August 2013. Random effects model was used for meta-analysis.
RESULTS
Four RCTs with a total of 165659 patients in the FS group and 249707 patients in the control group were included in meta-analysis. Intention-to-treat analysis showed that there was a 22% risk reduction in total incidence of CRC (RR = 0.78, 95%CI: 0.74-0.83), 31% in distal CRC incidence (RR = 0.69, 95%CI: 0.63-0.75), and 9% in proximal CRC incidence (RR = 0.91, 95%CI: 0.83-0.99). Those who underwent screening FS were 18% less likely to be diagnosed with advanced CRC (OR = 0.82, 95%CI: 0.71-0.94). There was a 28% risk reduction in overall CRC mortality (RR = 0.72, 95%CI: 0.65-0.80) and 43% in distal CRC mortality (RR = 0.57, 95%CI: 0.45-0.72).
CONCLUSION
This meta-analysis suggests that screening FS can reduce the incidence of proximal and distal CRC and mortality from distal CRC along with reduction in diagnosis of advanced CRC.
Topics: Colorectal Neoplasms; Early Detection of Cancer; Equipment Design; Humans; Incidence; Odds Ratio; Predictive Value of Tests; Randomized Controlled Trials as Topic; Risk Factors; Sigmoidoscopes; Sigmoidoscopy
PubMed: 25561818
DOI: 10.3748/wjg.v20.i48.18466 -
JAMA Network Open Feb 2024Randomized clinical screening trials have shown that sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and mortality. Colonoscopy has largely replaced... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Randomized clinical screening trials have shown that sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and mortality. Colonoscopy has largely replaced sigmoidoscopy for CRC screening, but long-term results from randomized trials on colonoscopy screening are still lacking.
OBJECTIVE
To estimate the additional screening benefit of colonoscopy compared with sigmoidoscopy.
DESIGN, SETTING, AND PARTICIPANTS
This comparative effectiveness simulation study pooled data on 358 204 men and women randomly assigned to sigmoidoscopy screening or usual care in 4 randomized sigmoidoscopy screening trials conducted in Norway, Italy, the US, and UK with inclusion periods in the years 1993 to 2001. The primary analysis of the study was conducted from January 19 to December 30, 2021.
INTERVENTION
Invitation to endoscopic screening.
MAIN OUTCOMES AND MEASURES
Primary outcomes were CRC incidence and mortality. Using pooled 15-year follow-up data, colonoscopy screening effectiveness was estimated assuming that the efficacy of colonoscopy in the proximal colon was similar to that observed in the distal colon in the sigmoidoscopy screening trials. The simulation model was validated using data from Norwegian participants in a colonoscopy screening trial.
RESULTS
This analysis included 358 204 individuals (181 971 women [51%]) aged 55 to 64 years at inclusion with a median follow-up time ranging from 15 to 17 years. Compared with usual care, colonoscopy prevented an estimated 50 (95% CI, 42-58) CRC cases per 100 000 person-years, corresponding to 30% incidence reduction (rate ratio, 0.70 [95% CI, 0.66-0.75]), and prevented an estimated 15 (95% CI, 11-19) CRC deaths per 100 000 person-years, corresponding to 32% mortality reduction (rate ratio, 0.68 [95% CI, 0.61-0.76]). The additional benefit of colonoscopy screening compared with sigmoidoscopy was 12 (95% CI, 10-14) fewer CRC cases and 4 (95% CI, 3-5) fewer CRC deaths per 100 000 person-years, corresponding to percentage point reductions of 6.9 (95% CI, 6.0-7.9) for CRC incidence and 7.6 (95% CI, 5.7-9.6) for CRC mortality. The number needed to switch from sigmoidoscopy to colonoscopy screening was 560 (95% CI, 486-661) to prevent 1 CRC case and 1611 (95% CI, 1275-2188) to prevent 1 CRC death.
CONCLUSIONS AND RELEVANCE
The findings of this comparative effectiveness study assessing long-term follow-up after CRC screening suggest that there was an additional preventive effect on CRC incidence and mortality associated with colonoscopy screening compared with sigmoidoscopy screening, but the additional preventive effect was less than what was achieved by introducing sigmoidoscopy screening where no screening existed. The results probably represent the upper limit of what may be achieved with colonoscopy screening compared with sigmoidoscopy screening.
Topics: Female; Humans; Male; Colonoscopy; Computer Simulation; Early Detection of Cancer; Neoplasms; Sigmoidoscopy; Comparative Effectiveness Research
PubMed: 38421651
DOI: 10.1001/jamanetworkopen.2024.0007 -
Current Oncology (Toronto, Ont.) Nov 2022Colorectal cancer (CRC) is the third most prevalent cancer, and the second most common cancer-related cause of death in the United States (USA). Timely screening reduces...
Colorectal cancer (CRC) is the third most prevalent cancer, and the second most common cancer-related cause of death in the United States (USA). Timely screening reduces both CRC incidence and mortality. Understanding population behaviors and factors that influence CRC screening is important for directing interventions targeted at reducing CRC rates. The 1997-2018 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for trends in colonoscopy and sigmoidoscopy utilization for CRC screening among adults in Georgia, USA. Overall, in Georgia, there has been an increase in the prevalence of colonoscopy and sigmoidoscopy utilization from 48.1% in 1997 to 71.2% in 2018 (AAPC = 2.30, < 0.001). Compared nationally, this increase was less pronounced (from 41.0% in 1997 to 73.7% in 2018 (AAPC = 2.90, < 0.001) overall for USA). Logistic regression analysis of the 2018 BRFSS data, adjusting for sociodemographic factors, shows that sex (female vs. male [aOR = 1.20, C.I. = 1.05, 1.38]); marital status (couple vs. single [aOR = 1.20, C.I. = 1.04, 1.39]); healthcare coverage (yes vs. no [aOR = 3.86, C.I. = 3.05, 4.88]); age (60-69 years [aOR = 2.38, C.I. = 2.02, 2.80], 70-79 [aOR = 2.88, C.I. = 2.38, 3.48] vs. 50-59 years); education (high school [aOR = 1.32, C.I. = 1.05, 1.65], some post high school [aOR= 1.63, C.I. = 1.29, 2.06], college graduate [aOR = 2.08, C.I. = 1.64, 2.63] vs. less than high school); and income ($25,000-$49,999 [aOR = 1.24, C.I. = 1.01, 1.51], $50,000+ [aOR = 1.56, C.I. = 1.27, 1.91] vs. <$25,000) were all significantly associated with colonoscopy and sigmoidoscopy utilization. In Georgia, a significant increase over time in colonoscopy and sigmoidoscopy utilization for CRC screening was observed pertaining to the associated sociodemographic factors. The findings from this study may help guide tailored programs for promoting screening among underserved populations.
Topics: Male; Female; United States; Humans; Middle Aged; Aged; Sigmoidoscopy; Early Detection of Cancer; Georgia; Colonoscopy; Colorectal Neoplasms
PubMed: 36421356
DOI: 10.3390/curroncol29110703 -
Preventive Medicine Mar 2019Flexible sigmoidoscopy (FS) screening has been shown to reduce colorectal cancer (CRC) incidence and mortality among screened adults. The aim of this review was to... (Review)
Review
Flexible sigmoidoscopy (FS) screening has been shown to reduce colorectal cancer (CRC) incidence and mortality among screened adults. The aim of this review was to identify patient-related factors associated with the screening test's use. We searched PubMed for studies that examined the association between FS screening use and one or more factors. To determine the eligibility of studies, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search, which we expanded successively (by adding 'OR' terms) until the number of new publications eligible after abstract review was <1% of the total number of publications. We then abstracted factors from eligible papers and reported the number of times each was found to be positively or negatively associated with FS screening use. We identified 42 papers, most of which reported studies conducted in the United States of America (n = 21, 50%) and the United Kingdom (n = 13, 31%). Across studies, a wide range of factors were examined (n = 123), almost half of which were found to be associated with FS screening use at least once (n = 60). Sociodemographic and health and lifestyle factors that were frequently positively associated with FS screening use included: male gender, higher socioeconomic status and a family history of CRC. Frequently positively associated psychosocial factors included low perceived barriers and high perceived benefits. Findings suggest that future research should focus on developing a theoretical framework of cancer screening behaviour to allow a greater level of consistency and specificity in measuring key constructs.
Topics: Adult; Age Factors; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male; Middle Aged; Patient Compliance; Risk Assessment; Sex Factors; Sigmoidoscopy; Socioeconomic Factors; United Kingdom
PubMed: 30597228
DOI: 10.1016/j.ypmed.2018.12.018 -
British Medical Journal Aug 1980
Topics: Ambulatory Care; Humans; Proctoscopy; Sigmoidoscopy
PubMed: 7427364
DOI: No ID Found -
British Medical Journal Sep 1980
Topics: Anesthesia, General; Humans; Proctoscopy; Sigmoidoscopy
PubMed: 7437766
DOI: No ID Found