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Public health
Original research
Colorectal cancer screening with faecal testing, sigmoidoscopy or colonoscopy: a systematic review and network meta-analysis
  1. Henriette C Jodal1,2,3,
  2. Lise M Helsingen1,2,3,
  3. Joseph C Anderson4,5,6,
  4. Lyubov Lytvyn7,
  5. Per Olav Vandvik8,9,
  6. Louise Emilsson1,10,11
  1. 1 Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
  2. 2 Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
  3. 3 Frontier Science Foundation, Boston, Massachusetts, USA
  4. 4 Veterans Affairs Medical Center, White River Junction, Vermont, USA
  5. 5 The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
  6. 6 University of Connecticut Health Center, Farmington, Connecticut, USA
  7. 7 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  8. 8 Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
  9. 9 Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
  10. 10 Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
  11. 11 Vårdcentralen Värmlands Nysäter & Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
  1. Correspondence to Dr Henriette C Jodal; h.c.jodal{at}medisin.uio.no

Abstract

Objective Evaluate effectiveness, harms and burdens of faecal blood testing, sigmoidoscopy and colonoscopy screening for colorectal cancer over 15 years.

Design We performed an update of a Cochrane systematic review, and performed network meta-analysis comparing randomised trials evaluating colorectal cancer screening with guaiac faecal occult blood test (gFOBT) (annual, biennial), faecal immunochemical test (FIT) (annual, biennial), sigmoidoscopy (once-only) or colonoscopy (once-only) in a healthy population, aged 50–79 years. We conducted subgroup analysis on sex. Follow-up >5 years was required for analysis of colorectal cancer incidence and mortality.

Results 12 randomised trials proved eligible. Compared with no-screening, we found high certainty evidence for sigmoidoscopy screening slightly reducing colorectal cancer incidence (relative risk (RR) 0.76; 95% confidence interval (CI 0.70 to 0.83) and mortality (RR 0.74; 95% CI 0.69 to 0.80), while gFOBT screening had little or no difference on colorectal cancer incidence, but slightly reduced colorectal cancer mortality (annual: RR 0.69; 95% CI 0.56 to 0.86, biennial: RR 0.88; 95% CI 0.82 to 0.93). No screening test reduced mortality nor incidence by more than six per 1000 screened over 15 years. Sigmoidoscopy had a greater effect in men, for both colorectal cancer incidence (women: RR 0.86; 95% CI 0.81 to 0.92, men: RR 0.75, 95% CI 0.71 to 0.79), and mortality (women: RR 0.85; 95% CI 0.71 to 0.96, men: RR 0.67; 95% CI 0.61 to 0.75) (moderate certainty).

Conclusions In a 15-year perspective, sigmoidoscopy reduces colorectal cancer incidence, while sigmoidoscopy, annual and biennial gFOBT all reduce colorectal cancer mortality. Sigmoidoscopy may reduce colorectal cancer incidence and mortality more in men than in women.

PROSPERO registration number CRD42018093401.

  • PUBLIC HEALTH
  • Gastroenterology
  • GENERAL MEDICINE (see Internal Medicine)

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-032773

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    Footnotes

    • Contributors HCJ drafted the protocol and the first draft of the review. HCJ, LMH and JCA performed data extraction. HCJ and LMH assessed risk of bias of included studies. HCJ and LE performed the statistical analyses. PV and LE supervised the study. HCJ, LMH, JCA, LL, PV and LE participated in writing the manuscript, interpretation of results and approval of the final version of the review. Corresponding author HCJ is the guarantor.

    • Funding The present work was funded by a PhD grant from the Norwegian Research Council (grant no 231920/F20). The default licence, a CC BY NC licence, is needed.

    • Disclaimer The funding sources had no role in the design, conduct or reporting of the study.

    • Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure and declare: no support from any organisation for the submitted work. POV is a member of the GRADE working group. JCA routinely see individuals eligible for colorectal cancer screening and is a co-writer on the American College of Gastroenterologists 2008 colorectal cancer screening guidelines. He is a member of the ACG, AGA, ASGE and the US Multi-Society Task Force for Colorectal Cancer Screening.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No additional data available.