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Flexible Sigmoidoscopy or Fecal Occult Blood Testing for Colorectal Cancer Screening in Asymptomatic Adults

 

Am Fam Physician. 2019 Aug 1;100(3):online.

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FLEXIBLE SIGMOIDOSCOPY OR FECAL OCCULT BLOOD TESTING FOR COLORECTAL CANCER SCREENING IN ASYMPTOMATIC ADULTS

BenefitsHarms

Flexible sigmoidoscopy: 1 in 450 did not die from colorectal cancer

Flexible sigmoidoscopy: 1 in 1,250 experienced an adverse outcome (bleeding, perforation, or death) within 30 days of screening from follow-up colonoscopy or surgery

Fecal occult blood testing: 1 in 900 did not die from colorectal cancer

Fecal occult blood testing: 1 in 3,300 experienced an adverse outcome (bleeding, perforation, or death) within 30 days of screening from follow-up colonoscopy or surgery

FLEXIBLE SIGMOIDOSCOPY OR FECAL OCCULT BLOOD TESTING FOR COLORECTAL CANCER SCREENING IN ASYMPTOMATIC ADULTS

BenefitsHarms

Flexible sigmoidoscopy: 1 in 450 did not die from colorectal cancer

Flexible sigmoidoscopy: 1 in 1,250 experienced an adverse outcome (bleeding, perforation, or death) within 30 days of screening from follow-up colonoscopy or surgery

Fecal occult blood testing: 1 in 900 did not die from colorectal cancer

Fecal occult blood testing: 1 in 3,300 experienced an adverse outcome (bleeding, perforation, or death) within 30 days of screening from follow-up colonoscopy or surgery

Details for This Review

Study Population: Asymptomatic adults 45 to 80 years of age

Efficacy End Points: Death from colorectal cancer, death from any cause

Harm End Points: Bleeding, perforation, or death resulting from follow-up colonoscopy or surgery

Narrative: Colorectal cancer continues to be the third leading cause of cancer death in the United States.1,2 The aim of screening is to reduce mortality through early detection.2,3 Several methods of colorectal cancer screening are available, including stool-based testing (guaiac fecal occult blood test, fecal immunochemical test), endoscopic methods (sigmoidoscopy, colonoscopy), and imaging methods with computed tomographic colonography among other new techniques.4 Fecal occult blood testing (FOBT) and flexible sigmoidoscopy have not been compared directly to determine whether either is the superior screening modality.1

The Cochrane meta-analysis cited here assessed the effectiveness of FOBT and flexible sigmoidoscopy as colorectal cancer screening modalities in asymptomatic patients.1 The primary outcome measured was

Author disclosure: No relevant financial affiliations.

References

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1. Holme ø, Bretthauer M, Fretheim A, Odgaard-Jensen J, Hoff G. Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals. Cochrane Database Syst Rev. 2013;(9):CD009259....

2. Jeon J, Du M, Schoen RE, et al.; Colorectal Transdisciplinary Study and Genetics and Epidemiology of Colorectal Cancer Consortium. Determining risk of colorectal cancer and starting age of screening based on lifestyle, environmental, and genetic factors. Gastroenterology. 2018;154(8):2152–2164.e19.

3. Provenzale D, Jasperson K, Ahnen DJ, et al.; National Comprehensive Cancer Network. Colorectal cancer screening, version 1.2015. J Natl Compr Canc Netw. 2015;13(8):959–968.

4. Lauby-Secretan B, Vilahur N, Bianchini F, Guha N, Straif K; International Agency for Research on Cancer Handbook Working Group. The IARC perspective on colorectal cancer screening. N Engl J Med. 2018;378(18):1734–1740.

5. U.S. Preventive Services Task Force. Colorectal cancer: screening. June 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening2. Accessed February 1, 2019.

 

 

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