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Colorectal Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Summary of Evidence

Table 2. Effect of Screening Intervention on Surrogate Endpoints (e.g., Stage at Diagnosis and Adenoma Detection)

Sigmoidoscopy[2,3]FOBT/ Sigmoidoscopy[4,5]Barium Enema[6]Colonoscopy[7,8]CT Colonography[9,10,11]Stool DNA Mutation Tests[12]Immunochemical FOBT
CRC = colorectal cancer; CT = computed tomography; FOBT = fecal occult blood test; iFOBT = immunochemical fecal occult blood test; N/A = not available.
Study DesignCase-control studiesRandomized controlled studiesEcologic and descriptive studiesEcologic and descriptive studiesEcologic and descriptive studiesStudies in progressCross-sectional study in which iFOBT is administered to persons receiving colonoscopy
Internal ValidityPoorFairFairFairFairUnknownGood
ConsistencyFairPoorPoorPoorPoorUnknownGood
Magnitude of Effects on Surrogate EndpointsAbout 45% decrease in detection rate of cancers compared with colonoscopyNo difference in diagnostic yield between sigmoidoscopy + FOBT vs. sigmoidoscopy aloneBarium enema detects about 30%–50% of cancers detected by colonoscopyAbout 3% of patients with no distal adenomas have advanced proximal neoplasia. There is a threefold increase in this rate in patients with distal adenomas.CT colonography may have similar sensitivity to colonoscopy in certain centersUnknowniFOBT detects >60% and ≤90% of CRCs
External ValidityPoorN/AN/AN/APoorUnknownN/A

References:

  1. Thiis-Evensen E, Hoff GS, Sauar J, et al.: Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scand J Gastroenterol 34 (4): 414-20, 1999.
  2. Cotterchio M, Manno M, Klar N, et al.: Colorectal screening is associated with reduced colorectal cancer risk: a case-control study within the population-based Ontario Familial Colorectal Cancer Registry. Cancer Causes Control 16 (7): 865-75, 2005.
  3. Schoenfeld P, Cash B, Flood A, et al.: Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 352 (20): 2061-8, 2005.
  4. Segnan N, Senore C, Andreoni B, et al.: Randomized trial of different screening strategies for colorectal cancer: patient response and detection rates. J Natl Cancer Inst 97 (5): 347-57, 2005.
  5. Gondal G, Grotmol T, Hofstad B, et al.: The Norwegian Colorectal Cancer Prevention (NORCCAP) screening study: baseline findings and implementations for clinical work-up in age groups 50-64 years. Scand J Gastroenterol 38 (6): 635-42, 2003.
  6. Winawer SJ, Stewart ET, Zauber AG, et al.: A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med 342 (24): 1766-72, 2000.
  7. Lieberman DA, Weiss DG, Bond JH, et al.: Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 343 (3): 162-8, 2000.
  8. Imperiale TF, Wagner DR, Lin CY, et al.: Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343 (3): 169-74, 2000.
  9. Pickhardt PJ, Choi JR, Hwang I, et al.: Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349 (23): 2191-200, 2003.
  10. Cotton PB, Durkalski VL, Pineau BC, et al.: Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA 291 (14): 1713-9, 2004.
  11. Mulhall BP, Veerappan GR, Jackson JL: Meta-analysis: computed tomographic colonography. Ann Intern Med 142 (8): 635-50, 2005.
  12. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al.: Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 351 (26): 2704-14, 2004.

WebMD Public Information from the National Cancer Institute

Last Updated: September 04, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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