Colorectal Cancer Screening: Scientific Review

来自 EBSCO

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ContextScreening for colorectal cancer clearly reduces colorectal cancer mortality,yet many eligible adults remain unscreened. Several screening tests are available,and various professional organizations have differing recommendations on whichscreening test to use. Clinicians are challenged to ensure that eligible patientsundergo colorectal cancer screening and to guide patients in choosing whattests to receive.ObjectiveTo critically assess the evidence for use of the available colorectalcancer screening tests, including fecal occult blood tests, sigmoidoscopy,colonoscopy, double-contrast barium enema, and newer tests, such as virtualcolonoscopy and stool-based molecular screening.Data SourcesAll relevant English-language articles were identified using PubMed(January 1966-August 2002), published meta-analyses, reference lists of keyarticles, and expert consultation.Data ExtractionStudies that evaluated colorectal cancer screening in healthy individualsand assessed clinical outcomes were included. Evidence from randomized controlledtrials was considered to be of highest quality, followed by observationalevidence. Diagnostic accuracy studies were evaluated when randomized controlledtrials and observational studies were not available or did not provide adequateevidence. Studies were excluded if they did not evaluate colorectal screeningtests and if they did not evaluate average-risk individuals.Data SynthesisRandomized controlled trials have shown that fecal occult blood testingcan reduce colorectal cancer incidence and mortality. Case-control studieshave shown that sigmoidoscopy is associated with a reduction in mortality,and observational studies suggest colonoscopy is effective as well. Combiningfecal occult blood testing and sigmoidoscopy may decrease mortality and canincrease diagnostic yield.ConclusionThe recommendation that all men and women aged 50 years or older undergoscreening for colorectal cancer is supported by a large body of direct andindirect evidence. At present, the available evidence does not currently supportchoosing one test over another.

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关键词：

colonoscopy colorectal cancer fecal occult blood test sigmoidoscopy screening colorectal cancer screening air contrast barium enema computed tomographic colonography screening test feces