Colorectal Cancer Screening Modalities: Variable Uptake, Variable Yield


Am Fam Physician. 2016 Jun 15;93(12):1032a-1036.

Clinical Question

How acceptable are various colorectal cancer screening modalities, and what is the yield in population-based screening programs?

Bottom Line

Based on the initial round of screening in this randomized trial, it appears that more patients complete fecal immunochemical testing (FIT) than colonography or colonoscopy. Using the most conservative estimate, the yields of advanced adenomas and advanced neoplasms are similar. If considering only those participants who were actually screened (not the total number invited to participate), colonoscopy found more of these lesions but also had the lowest participation rate. (Level of Evidence = 2b)


These researchers assigned 16,087 patients to one of four screening approaches: three cycles of FIT every two years (n = 9,739), a single reduced-preparation computed tomographic colonography (n = 2,617), a single full-preparation computed tomographic colonography (n = 2,625), or a single colonoscopy (n = 1,106). The participants were all residents of a single region in Italy, were between 55 and 64 years of age, and had not had recent colorectal cancer screening. If a FIT result or any of the colonography results were abnormal, the patients were invited to have colonoscopy. One of two experienced pathologists evaluated all the colorectal lesions; the paper does not report if they were aware of allocation. The researchers classified lesions as follows: hyperplastic polyp; or serrated, tubular, tubulovillous, or villous adenoma or adenocarcinoma. Additionally, they defined advanced adenoma as being greater than 9 mm or with more than 20% villous histologic component or with severe dysplasia (or any combination of these). They also defined advanced neoplasia as cancer or advanced adenoma. Finally, to avoid differential participation in the program, spouses were clustered to the same screening modality.

This paper presents data from the first screening round. Slightly more than one-half of the patients were women and

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.



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Jun 15, 2017

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