Abstract
Simple SummaryThis study is a systematic review and meta-analysis of international literature on the achievements of various performance indicators for colorectal cancer screening programs. We systematically summarized performance indicators of organized colorectal cancer screening that used fecal immunochemical test as a primary screening modality, and colonoscopy as a subsequent confirmatory test, from 93 studies involving nearly 90 million people-times, and reported their pooled achievements based on random-effects models. We also performed meta-regression and subgroup analyses to explore the heterogeneity. Our findings could help to identify the areas that could be improved and finally optimize the organized colorectal cancer screening programs.(1) Background: To summarize the achievements of the performance indicators of colorectal cancer (CRC) screening programs that used the fecal immunochemical test (FIT) as a primary screening modality and colonoscopy as a subsequent confirmatory test. (2) Methods: PubMed, Ovid MEDLINE, Embase, and Cochrane were searched from inception to September 2020. We included original articles published in English, and performed hand searching for relevant national reports. We generated pooled achievement estimates of the performance indicators by “metaprop” (R software 3.6.3). Meta-regression analyses and subgroup analyses were also conducted. (3) Results: We included 93 studies involving nearly 90 million people-times. The participation rate ranged from 6.80% to 95.98%, which was associated with study type, continents, FIT number, age, and round. The pooled FIT invalid rate and positivity rate were 1.08% and 7.28%, respectively. The pooled estimates of FIT detection were 2.26% for adenoma, 1.26% for advanced adenoma, and 0.28% for CRC. In addition, only seven studies reported that their colonoscopy compliance rate reached 90% among 69 studies. The colonoscopy completion rate (21/40 studies > 95%) and the complication rate (18/27 studies < 0.5%) were acceptable. (4) Conclusions: Our findings could help to identify the areas that could be improved and finally optimize the CRC screening programs.
Highlights
Worldwide, colorectal cancer (CRC) is the third most common cancer, and it was responsible for 10.2% of all new cancer cases and 9.4% of cancer-related deaths in 2020 [1].According to recent studies, guaiac-based fecal occult blood test, fecal immunochemical test (FIT), flexible sigmoidoscopy (FS), and colonoscopy were associated with a reduction of 14–16% [2], 22% [3], 28% [4], and 68% [5] of all CRC-related deaths, respectively
Guaiac-based fecal occult blood test, fecal immunochemical test (FIT), flexible sigmoidoscopy (FS), and colonoscopy were associated with a reduction of 14–16% [2], 22% [3], 28% [4], and 68% [5] of all CRC-related deaths, respectively
The exclusion criteria included the following: (1) randomized controlled trial and cost-effectiveness analysis; (2) studies on opportunistic screening, screening restricted in clinics, and screening targeting at special groups; (3) programs that included the use of other screening tools; (4) studies that examined outcomes other than performance indicators, such as CRC incidence or mortality; and (5) literature reviews, abstracts, or articles in other languages
Summary
Colorectal cancer (CRC) is the third most common cancer, and it was responsible for 10.2% of all new cancer cases and 9.4% of cancer-related deaths in 2020 [1]. Guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), flexible sigmoidoscopy (FS), and colonoscopy were associated with a reduction of 14–16% [2], 22% [3], 28% [4], and 68% [5] of all CRC-related deaths, respectively. Among these screening tools, FIT had a higher participation rate and positivity rate compared to gFOBT in the CRC screening programs [6]. This was the first systematic review on the performance of all eligible population-based CRC screening programs that used FIT as a primary screening test, and colonoscopy as a subsequent confirmatory test, in various countries, and we conducted meta-regression analyses and subgroup analyses to identify factors such as study type, continents, and age groups
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