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Single-round performance of colorectal cancer screening programs: a network meta-analysis of randomized clinical

Teruhiko Terasawa¹, Toshihiro Tadano², Koichiro Abe³

¹Section of General Internal Medicine, Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan. terasawa@fujita-hu.ac.jp.

|February 22, 2025

Summary

This summary is machine-generated.

Immunochemical fecal occult blood testing (FIT) programs detect more advanced neoplasia than guaiac-based FOBT. Visual screening methods like flexible sigmoidoscopy, CT colonography, and total colonoscopy may offer superior advanced neoplasia detection compared to FIT in colorectal cancer screening.

Keywords:

Colorectal cancer screening Computed tomographic colonography Fecal immunochemical test Flexible sigmoidoscopy Total colonoscopy

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Area of Science:

Gastroenterology
Preventive Medicine
Oncology

Background:

Demonstrating mortality reduction from new colorectal cancer (CRC) screening programs via randomized clinical trials (RCTs) is challenging.
Systematic review of single-round program performance using the World Endoscopy Organization CRC Screening Committee framework.

Purpose of the Study:

To systematically review and compare the performance of various colorectal cancer screening modalities in their first round.
To evaluate advanced neoplasia detection, participation rates, and CRC detection across different screening strategies.

Main Methods:

Network meta-analysis of 18 RCTs (437,072 participants) comparing guaiac-based FOBT (gFOBT), FIT, flexible sigmoidoscopy (FS), CT colonography (CTC), and total colonoscopy (TCS).
Bayesian random-effects model used; certainty of evidence assessed using GRADE.
Primary outcome: advanced neoplasia (AN) detection; secondary outcomes: participation and CRC detection.

Main Results:

FIT programs showed higher AN detection than gFOBT programs (RR 2.48; moderate certainty).
FS, CTC, and TCS programs demonstrated higher AN detection rates than FIT (low certainty).
CRC detection conclusions were limited by low event rates; TCS had the lowest participation rate.

Conclusions:

FIT programs likely detect more AN than gFOBT programs.
Visual screening modalities (FS, CTC, TCS) may outperform FIT in AN detection.
Long-term outcomes require assessment after 10-15 years due to limitations in first-round data.