Author/Authors :
Tinmouth, Jill Prevention and Cancer Control - Cancer Care Ontario, Toronto,Canada , Vella, Emily T Program in Evidence-Based Care - Cancer Care Ontario, Hamilton, Canada , Baxter, Nancy N Prevention and Cancer Control - Cancer Care Ontario, Toronto,Canada , Dubé, Catherine Prevention and Cancer Control - Cancer Care Ontario, Toronto,Canada , Gould, Michael William Osler Health Centre, Etobicoke, Canada , Hey, Amanda Northeast Cancer Centre Health Sciences North/Horizon Sante-Nord - Sudbury Outpatient Centre, Sudbury, Canada , Ismaila, Nofisat American Society of Clinical Oncology, Alexandria, USA , McCurdy, Bronwen R. Prevention and Cancer Control - Cancer Care Ontario, Toronto,Canada , Paszat, Lawrence Department of Medicine - Sunnybrook Health Sciences Centre, Toronto, Canada
Abstract :
Introduction. The objectives of this systematic review were to evaluate the evidence for different CRC screening tests and to determine the most appropriate ages of initiation and cessation for CRC screening and the most appropriate screening intervals for selected CRC screening tests in people at average risk for CRC. Methods. Electronic databases were searched for studies that addressed the research objectives. Meta-analyses were conducted with clinically homogenous trials. A working group reviewed the evidence to develop conclusions. Results. Thirty RCTs and 29 observational studies were included. Flexible sigmoidoscopy (FS) prevented CRC and led to the largest reduction in CRC mortality with a smaller but significant reduction in CRC mortality with the use of guaiac fecal occult blood tests (gFOBTs). There was insufficient or low quality evidence to support the use of other screening tests, including colonoscopy, as well as changing the ages of initiation and cessation for CRC screening with gFOBTs in Ontario. Either annual or biennial screening using gFOBT reduces CRC-related mortality. Conclusion. The evidentiary base supports the use of FS or FOBT (either annual or biennial) to screen patients at average risk for CRC. This work will guide the development of the provincial CRC screening program.
