Ethical issues with colorectal cancer screening-a systematic review

Area of Science:

• Public Health
• Medical Ethics
• Health Technology Assessment

Background:

• Colorectal cancer (CRC) screening is recommended but implementation varies, with some screening types lacking evidence.
• Ethical considerations are crucial for transparent deliberation on CRC screening practices.

Purpose of the Study:

• To identify and analyze ethical issues in the literature concerning colorectal cancer screening.
• To inform open and transparent discussions regarding CRC screening implementation and evidence.

Main Methods:

• An axiological, question-based method was employed for ethical analysis.
• A comprehensive literature search across multiple databases identified 114 relevant studies for ethical review.

Main Results:

• Identified benefits include reduced relative CRC mortality and incidence, but no evidence of absolute mortality reduction.
• Potential harms encompass bleeding, perforation, false results, overdiagnosis, overtreatment, and rare fatalities.
• Ethical concerns also involve autonomy, informed choice, equity, justice, medicalization, and disease expansion.

Conclusions:

• Significant ethical issues in CRC screening have been identified.
• These ethical considerations necessitate open and transparent deliberation to guide screening practices.