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The efficacy of colorectal cancer screening: a systematic review and meta-analysis
Sai Nyan Lin Tun1, Noppcha Singweratham1, Pallop Siewchaisakul1
1Faculty of Public Health, Chiang Mai University, Thailand.
Objective:
To estimate sensitivity and specificity for two major colorectal cancer screening tests in asymptomatic average-risk adults: fecal immunochemical testing and colonoscopy.
Methods:
This review was registered in the International Prospective Register of Systematic Reviews (CRD420250635078) on 7 January 2025 and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and Scopus were searched without publication date restrictions from database-specific inception dates to 26 June 2025: PubMed from 1946 and Scopus from 1788. Randomized trials and observational studies were screened using predefined eligibility criteria. Risk of bias was assessed using Cochrane tools and the Risk of Bias in Non-randomized Studies of Interventions tool.
Results:
Seventeen studies met inclusion criteria. Fecal immunochemical testing had a pooled sensitivity of 77% (95% CI: 67%-85%) and specificity of 95% (95% CI: 93%-96%). Colonoscopy showed higher performance, with sensitivity of 97% (95% CI: 91%-99%) and specificity of 99% (95% CI: 96%-100%). Subgroup analyses indicated variation in fecal immunochemical testing sensitivity across study designs and income settings, whereas specificity remained high.
Conclusions:
Colonoscopy remains the benchmark for colorectal cancer detection, while fecal immunochemical testing is a practical, non-invasive option where colonoscopy capacity is limited.
